Icodextrin dialysate improves nutritional and inflammatory profiles in peritoneal dialysis patients

Background. Previous studies demonstrate that icodextrin is superior to 4.25% dextrose for fluid removal in patients with high and high-average transport membrane. Recent studies reveal that controlling volume status improves malnutrition in peritoneal dialysis (PD) patients. This study hypothesized that icodextrin enhances nutritional and inflammatory status by improving fluid balance. Methods. This retrospective case-control study investigated the effects of icodextrin on patient nutritional profiles over a one-year period. Thirty-two patients who used icodextrin for more than one year were classified as the "icodextrin group." Ten patients who used glucose-containing dialysate without icodextrin were classified as the control group. Clinical and laboratory parameters were compared between groups. Demographic and laboratory parameters were analyzed at baseline, 3 months, 6 months, and 12 months after starting icodextrin dialysis. Results. Ultrafiltration of icodextrin per exchange in the icodextrin group was 66% higher than that for 4.25% dextrose exchange in the icodextrin group (icodextrin vs. 4.25% dextrose: 492.1 ± 204.5 vs. 296.1 ± 115.3 mL/exchange; p <0.0001, paired t-test). The increased albumin and normalized protein catabolic rate (nPCR) after icodextrin for one year was unique for the icodextrin group (p <0.0001 and p <0.0001, respectively). The inflammatory marker high sensitivity C-reactive protein (hsCRP) decreased significantly only in the icodextrin group (p = 0.0048). Conclusion. Icodextrin dialysate may improve nutritional and inflammatory status in PD patients. However, the long-term clinical effects of icodextrin require further study.