Allergy to icodextrin

Timely Initiation of Dialysis — Single-Exchange Experience in 39 Patients Starting Peritoneal Dialysis

♦ Objective

To establish the effectiveness and patient acceptability of initiating peritoneal dialysis (PD) according to published guidelines.

♦ Setting

A university teaching hospital and a neighboring district general hospital.

♦ Design

Nonrandomized prospective pilot study.

♦ Patients

39 patients with a Kt/V > 2.0 attending predialysis clinics at both hospitals agreed to participate in this study.

♦ Methods

Patients were started on a single exchange of dialysate overnight. Dialysis adequacy was monitored at least every 2 months and incremental increases in dialysis were used to maintain combined urinary and dialysis Kt/V above 2.0. Routine laboratory parameters and complications of dialysis were monitored during the follow-up period.

♦ Results

The mean weekly Kt/V at initiation of dialysis was 2.09. Median actuarial survival on a single exchange before requiring incremental dialysis was 297 days. At the end of the study period, all patients were still alive: 8 remained on 1 exchange, 18 were on more than 1 exchange, 8 had switched to hemodialysis, and 5 had received renal transplants. During the 12 665 patient-days on single-exchange dialysis, there were 14 hospital admissions of 12 patients. This resulted in a mean of 1.64 hospital days per patient–year for the whole group. During the follow-up period there were 2 episodes of bacterial peritonitis, 3 pleural leaks, 1 patent processus vaginalis, and 1 inguinal hernia that required surgical intervention. The use single daily icodextrin exchanges was associated with a 46% incidence of culture-negative peritonitis.

♦ Conclusions

This pilot study has shown that a timely start of dialysis with a single overnight PD exchange is acceptable to patients. Incremental dialysis as residual renal function falls is easily managed and patients also find this acceptable. Complication and hospitalization rates were low. The presence of residual renal function often allows complications to be managed without the need for hemodialysis. The use of icodextrin as a single-exchange dialysate is associated with sterile peritonitis in a significant proportion of cases.

Icodextrin-associated generalized exfoliative skin rash in a CAPD patient: a case-report

Background

Case presentation

Conclusions

Icodextrin Peritoneal Dialysis Solution

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Impact of fill volume on ultrafiltration with icodextrin in children on chronic peritoneal dialysis

BACKGROUND

Icodextrin is a solution of glucose polymers developed to provide sustained ultrafiltration over an extended dwell. Our aim was to determine whether or not fill volume with icodextrin contributes to the ability to achieve ultrafiltration in children.

METHODS

The charts of all children on chronic peritoneal dialysis between January 2000 and July 2014 were screened for the use of an icodextrin day dwell. Data were extracted from the electronic chart and the HomeChoice™ Pro card and corrected for body surface area (BSA).

RESULTS

Fifty children had an icodextrin day dwell. A linear correlation was found between the daytime fill volume and net ultrafiltration (p < 0.001). More ultrafiltration was achieved with a fill volume above 550 ml/m(2) BSA (107 ± 75 ml/m(2) BSA) than with smaller fill volumes (-8 ± 99 ml; p = 0.004). Ultrafiltration was achieved in 88 % of children with a fill volume above 550 ml/m(2) BSA versus only 44 % of patients with a smaller fill volume (p = 0.001). Icodextrin was well tolerated.

CONCLUSIONS

Our observations reveal that the larger the fill volume the higher the likelihood of achieving ultrafiltration with icodextrin and suggest that a minimum day dwell volume of 550 ml/m(2) BSA seems to facilitate ultrafiltration in children. To our knowledge this is the largest study addressing ultrafiltration with icodextrin in children.

Relapsing culture-negative peritonitis in peritoneal dialysis patients exposed to icodextrin solution

BACKGROUND

Icodextrin is a new peritoneal dialysis fluid, with maltose polymers providing the osmotic drive, that may extend time on peritoneal dialysis in situations in which use of conventional glucose-based peritoneal dialysis fluid (Dianeal) has led to loss of ultrafiltration. Although cutaneous reactions have been reported, we report a new phenomenon of aseptic peritonitis that has arisen in our unit associated with icodextrin use.

METHODS

Icodextrin was first introduced in our unit in 1997 and was used extensively beginning in late 1999. From a combination of an observational study of 141 patients in our unit in whom icodextrin was used over 3.5 years and our unit 2000 and 2001 peritonitis audits, we identified an increase in the incidence of culture-negative peritonitis (CNP).

RESULTS

The rate in 2000 of 12.3% rose to 17% in 2001, but this increase was seen only in patients on icodextrin (Percentage changes 2000 audit > 2001 audit: icodextrin patients, 14%--31% increase; Dianeal alone, 12%--10% increase; P < 0.05). Six patients were affected in the period 2000 to 2001 out of a total of 141 patients exposed to icodextrin (4.3%). Two index cases of relapsing CNP responded after withdrawal of the icodextrin. We then adopted a protocol of cessation and rechallenge with icodextrin when dealing with CNP, which successfully confirmed the phenomenon and led to resolution of relapsing CNP after icodextrin withdrawal. All these patients had been on icodextrin for some time, and none had had an immediate reaction or any skin reaction. Eosinophils were reported in the peritoneal effluent from two patients. All patients continued Dianeal without further CNP episodes.

CONCLUSION

Icodextrin use carries the risk of CNP, and we suggest a cessation and rechallenge protocol in all patients on icodextrin who have CNP.