Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Icodextrin (Extraneal®) is a high molecular weight glucose polymer developed specifically for use as an alternative osmotic agent to dextrose during the once-daily long-dwell exchange in peritoneal dialysis (PD).
Isosmotic 7.5% icodextrin solution induces transcapillary ultrafiltration (UF) by a mechanism resembling ‘colloid’ osmosis (unlike hyper-osmolar dextrose-based solutions, which induce UF by crystalline osmosis). In addition, absorption of icodextrin from the peritoneal cavity is relatively slow compared with that of dextrose; this results not only in UF of longer duration, but also a lower carbohydrate load compared with medium (2.5%) and strong (4.25%) dextrose exchanges.
In randomised clinical trials of up to 2 years in duration, administration of icodextrin for the long (8- to 16-hour) overnight exchange in continuous ambulatory peritoneal dialysis (CAPD) or daytime exchange in automated peritoneal dialysis (APD) produced net UF which exceeded that with 1.5% and 2.5% dextrose solutions (thereby improving fluid balance), and was equivalent to that with 4.25% dextrose solution. Icodextrin also increased peritoneal clearances of creatinine and urea nitrogen compared with 2.5% dextrose solution. The increase in UF volume with icodextrin was enhanced in CAPD patients with high peritoneal membrane permeability (i.e. high and high-average transporters), maintained in the small number of patients followed-up for 2 years and sustained during episodes of peritonitis. Icodextrin reduced the percentage of patients with net negative UF in contrast to 1.5% and 2.5% dextrose and, in noncomparative studies, extended PD technique survival in patients who had failed dextrose-based dialysis. The use of icodextrin was also associated with some symptomatic improvements and health-related quality of life advantages, and no adverse effect on patient survival, compared with dextrose, although confirmation of these findings is ideally required in appropriately designed studies.
The tolerability of icodextrin was generally similar to that of dextrose-based solutions in controlled clinical trials, although there was an approximate three-fold increase in the risk of new skin rash (5.5% vs 1.7%). However, reports of severe cutaneous hypersensitivity reactions remain rare; this possibility should not preclude the use of the polymer.
Conclusion: 7.5% icodextrin solution offers the first feasible alternative to conventional dextrose solutions for the once-daily long-dwell exchange in PD. It is effective, generally well tolerated and appears to be most useful in situations of reduced or inadequate UF with dextrose, including in high and high-average transporters, during episodes of peritonitis and patients who have failed dextrose-based dialysis.
Icodextrin, a starch-derived, water-soluble, glucose polymer (average molecular weight 16.8kDa) linked predominantly by α1–4 glucosidic bonds, induces trans-capillary ultrafiltration (UF; removal of excess fluid from the plasma) by a mechanism resembling ‘colloid’ osmosis. Thus, icodextrin-based peritoneal dialysis (PD) solutions can be iso-osmotic with respect to normal plasma, unlike hyper-osmotic dextrose-based solutions, which produce UF by crystalline osmosis.
Intraperitoneal administration of PD solution containing 7.5% icodextrin provides sustained UF throughout the once-daily long-dwell exchange (8–16 hours) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD); the effect on UF is immediate with the first exchange. UF volumes with icodextrin are equivalent to those with ‘strong’ (4.25%) dextrose solutions; compared with ‘weak’ (1.5%) and ‘medium’ (2.5%) dextrose solutions, icodextrin increases UF and improves fluid balance. Interestingly, in a 4-month randomised multicentre trial, treatment with icodextrin, but not 1.5% dextrose, was associated with a significant 5% reduction in left ventricular hypertrophy, an effect that was unrelated to changes in volume status or blood pressure.
Due to the relatively slow rate of absorption of icodextrin from the peritoneal cavity (which accounts for the prolonged UF effect) the carbohydrate load per exchange is lower than that with 2.5% and 4.25% dextrose solutions. Beneficial effects of icodextrin on insulin sensitivity and plasma lipids (significant reductions in total and low-density lipoprotein cholesterol levels) compared with dextrose have also been observed in some studies. These reports notwithstanding, the incidences of hyperglycaemia (5% vs 4%) and hypercholesterolaemia (2% vs 2%) were similar for icodextrin and dextrose in a pooled analysis of data from controlled clinical trials.
Preclinical data suggesting that icodextrin may be a more biocompatible osmotic agent than dextrose have recently received some clinical support. Specifically, icodextrin appeared to have a less deleterious effect on membrane function, especially compared with 2.5% and 4.25% dextrose, in a 2-year prospective study in 177 anuric APD patients. However, neither icodextrin nor 1.5–4.25% dextrose solutions had clinically meaningful effects on peritoneal membrane characteristics during 1–2 years of treatment in randomised studies of nonanuric CAPD patients.
Icodextrin is absorbed at a constant rate from the peritoneal cavity, mostly via lymphatic pathways. The amount of icodextrin absorbed thus depends on the dwell time; it represents approximately 40% of the administered dose after a 12-hour exchange. Up to 80% of the absorbed icodextrin dose is eventually metabolised, first by circulating α-amylases and then by tissue maltases, into glucose; the remaining 20% is eliminated via the urine (in direct proportion to the level of residual renal function) or in the dialysate.
The plasma profile of icodextrin and its three main metabolites (maltose, maltotriose, and maltotetraose) fits a simple one-compartment model assuming zero-order absorption and first-order elimination. Peak plasma concentrations are reached at the end of a 12-hour dwell and decline to baseline levels within 3–7 days following a single icodextrin exchange. Concentrations of the main icodextrin metabolites in the dialysate also rise during the dwell, either as a result of diffusion from the plasma (maltose) or intraperitoneal metabolism of other, minor metabolites (in the case of maltotriose and maltotetraose), although this has no effect on the osmolality of the solution.
The steady-state plasma concentration of icodextrin plus its main metabolites (typically 5–6 g/L) is reached within 7–10 days, with the metabolites accounting for approximately 40% of the total measured polymers. Maltose accumulation is avoided by limiting the use of icodextrin to the once-daily long-dwell exchange.
The effects of 7.5% icodextrin solution used once daily for the long-dwell exchange in PD have been compared with those of standard dextrose solutions in several clinical trials of up to 2 years in length. These trials include four pivotal, multicentre, randomised studies: three (versus 1.5% and 4.25% dextrose in CAPD [n = 209], 2.5% dextrose in CAPD [n = 175] and 2.5% dextrose in APD [n = 39]) evaluating the short-term (≤6 months) UF efficacy of icodextrin; and one (versus 2.5% dextrose in CAPD or APD [n = 278]) assessing the long-term (1-year) effects of the polymer on patient survival and health-related quality of life (HR-QOL).
The effects of icodextrin on UF and small solute (e.g. creatinine, urea nitrogen) clearances were broadly similar when administered for the long overnight exchange (8–16 hours) in patients undergoing CAPD or the long daytime exchange (12–16 hours) in patients receiving APD. The increase in UF volume with icodextrin was maintained in a small number of patients (12 CAPD, 7 APD) foliowed-up for 2 years and preserved during episodes of peritonitis. Net UF during the long-dwell exchange with icodextrin was significantly greater than that with 1.5% and 2.5% dextrose solutions, and was similar to that with 4.25% dextrose solution. Icodextrin also reduced the percentage of patients with net negative UF in contrast to 1.5% and 2.5% dextrose. In a double-blind study in 175 patients undergoing CAPD, the average net UF during the 1-month treatment period was 1.7 times higher with icodextrin than with 2.5% dextrose (587 vs 356mL; p < 0.001); the greatest relative benefit with icodextrin was seen in high and high-average transporters. In addition, the average peritoneal clearances of creatinine and urea nitrogen were 1.1 times higher with icodextrin than with 2.5% dextrose (4 vs 3.5 mL/min and 4.5 vs 4.1 mL/min, respectively; p ≤ 0.001).
Available data suggest that CAPD patients receiving icodextrin for 6–12 months experience some symptomatic improvements and HR-QOL advantages compared with those receiving dextrose. Overall, perceived HR-QOL declined in a double-blind study in 278 patients receiving CAPD or APD, although the deterioration was less in patients treated with icodextrin, with 30% considering themselves to be much better now than 1 year ago compared with only 4% of those receiving 2.5% dextrose (p < 0.05). Similarly, available data suggest that treatment with icodextrin does not, on the whole, adversely affect patient survival and, furthermore, may extend PD technique survival in patients with UF failure who are on the point of transferring to haemodialysis.
Pooled data from controlled clinical trials (n = 840) suggest that, while in general icodextrin is as well tolerated as conventional dextrose-based solutions, it is three times more likely to cause new skin rash (5.5% vs 1.7%). A total of 265 patients were randomised to icodextrin in two pivotal multicentre, randomised, double-blind studies conducted in North America; of these, eight (3%) discontinued the polymer because of rash or exfoliative dermatitis. There have also been several reports of serious cutaneous hypersensitivity reactions occurring in clinical practice, although these remain rare overall. Pharmacovigilance data provided by the manufacturer suggest that most skin eruptions (incidence rate ≈2.5%) are mild, while more than half are self-limiting.
Use of icodextrin was not associated with an increased frequency of peritonitis or exit-site infections in large-scale clinical trials. There have, however, been several reports of icodextrin-associated aseptic peritonitis attributed to contamination of some batches of the manufactured product with peptidoglycan.
Body weight was little changed during 6–12 months of treatment with icodextrin or dextrose, with the notable exception of a significant (p < 0.05) 2.3kg increase with dextrose in the 1-year double-blind study in 278 patients receiving CAPD or APD. Overall, oedema occurred with a similar frequency in patients treated with icodextrin or dextrose in controlled clinical trials (6% vs 5%). Slight decreases in plasma sodium and chloride levels are attributed to a dilutional effect of icodextrin metabolites in the plasma, as are small increases in osmolality and alkaline phosphatase levels. However, these laboratory changes are not clinically significant.
Dosage and Administration
PD solution containing 7.5% icodextrin is indicated as a single daily exchange for the long (8- to 16-hour) dwell during CAPD or APD for the management of end-stage renal failure. It is contraindicated, however, in patients with a known allergy to cornstarch and those with glycogen storage disease.
Patients and physicians should follow all the normal procedures and precautions regarding intraperitoneal administration of dialysis solutions. In particular, not more than one long-dwell icodextrin exchange should be performed in a 24-hour period.
Importantly, plasma glucose levels in insulin-dependent diabetic PD patients must be measured using glucose-specific tests to avoid interference by icodextrin and its metabolites (resulting in erroneously high estimates of glycaemia). Icodextrin and its metabolites also interfere with enzymatic-based plasma amylase activity assays (resulting in inaccurately low values).
- Gokal R. Peritoneal dialysis in the 21st century: an analysis of current problems and future developments. J Am Soc Nephrol 2002; 13 Suppl. 1: S104–16
- Anon. Peritoneal dialysis dose and adequacy [online]. Available from URL: http://kidney.niddk.nih.gov/kudiseases/pubs/peritonealdose/index.htm [Accessed 2003 Jul 31]
- Anon. Peritoneal dialysis [online]. Available from URL: http://www.kidney.org.uk/Medical-Info/pd.html [Accessed 2003 Jun 19]
- Krediet RT. Osmotic agents in automated peritoneal dialysis solutions. Contrib Nephrol 1999; 129: 177–86 CrossRef
- Peers E, Gokal R. Icodextrin: overview of clinical experience. Perit Dial Int 1997 Jan; 17(1): 22–6
- Shockley TR, Martis L, Tranaeus AP. New solutions for peritoneal dialysis in adult and pediatric patients. Perit Dial Int 1999; 19 Suppl. 2: S429–34
- Gokal R. Newer peritoneal dialysis solutions. Adv Ren Replace Ther 2000 Oct; 7(4): 302–9 CrossRef
- Wang T, Lindholm B. Peritoneal dialysis solutions. Perit Dial Int 2001; 21 Suppl. 3: S89–95
- Mistry CD, Gokal R. The use of glucose polymer (icodextrin) in peritoneal dialysis: an overview. Perit Dial Int 1994; 14 Suppl. 3: S158–61
- Wolfson M, Piraino B, Hamburger RJ, et al. A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis. Am J Kidney Dis 2002 Nov; 40(5): 1055–65 CrossRef
- Krediet RT, van Westrhenen R, Zweers MM, et al. Clinical advantages of new peritoneal dialysis solutions. Nephrol Dial Transplant 2002; 17 Suppl. 3: 16–8 CrossRef
- ML Laboratories PLC. US Marketing Approval for Dialysis Solution [online; media release]. Available from URL: http://www.mllabs.co.uk. [Accessed 1 Aug 2003]
- ML Laboratories PLC. Peritoneal dialysis solution product launched in US market and marketing approval granted in Japan [online; media release]. Available from URL: http://www.mllabs.co.uk [Accessed 1 Aug 2003]
- Peers E, Gokal R. Icodextrin provides long dwell peritoneal dialysis and maintenance of intraperitoneal volume. Artif Organs 1998 Jan; 22(1): 8–12 CrossRef
- Baxter Healthcare Corporation. Extraneal (icodextrin) peritone-al dialysis solution package insert. Deerfield (IL): Baxter Healthcare Corporation. 2001
- Alsop RM. History, chemical, and pharmaceutical development of icodextrin. Perit Dial Int 1994; 14 Suppl. 2: S5–12
- Schroder CH, Edefonti A, Fischbach M, et al. The choice of dialysis solutions in pediatric chronic peritoneal dialysis: guidelines by an ad hoc European committee. Perit Dial Int 2001; 21(6): 568–74
- Mistry CD, Mallick NP, Gokal R. Ultrafiltration with an isosmotic solution during long peritoneal dialysis exchanges. Lancet 1987; ii(8552): 178–82 CrossRef
- Posthuma N, ter Wee PM, Verbrugh HA, et al. Icodextrin instead of glucose during the daytime dwell in CCPD increases ultrafiltration and 24-h dialysate creatinine clearance. Nephrol Dial Transplant 1997 Mar; 12(3): 550–3 CrossRef
- Gokal R, Moberly J, Lindholm B, et al. Metabolic and laboratory effects of icodextrin. Kidney Int 2002 Oct; 62 Suppl. 81: S62–71 CrossRef
- Posthuma N, Verbrugh HA, Donker AJM, et al. Peritoneal kinetics and mesothelial markers in CCPD using icodextrin for daytime dwell for two years. Perit Dial Int 2000 Mar; 20(2): 174–80
- Davies SJ, Brown EA, Riegel W, et al. Influence of glucose exposure and icodextrin use on longitudinal changes in membrane function in anuric APD patients [abstract]. Perit Dial Int 2003; 23 Suppl. 1: S17
- Posthuma N, ter Wee P, Donker AJM, et al. Peritoneal defense using icodextrin or glucose for daytime dwell in CCPD patients. Perit Dial Int 1999 Jul; 19(4): 334–42
- Ho-dac-Pannekeet MM, Schouten N, Langendijk MJ, et al. Peritoneal transport characteristics with glucose polymer based dialysate. Kidney Int 1996 Sep; 50(3): 979–86 CrossRef
- Araujo Teixeira MR, Pecoits-Filho RF, Romao Junior JE, et al. The relationship between ultrafiltrate volume with icodextrin and peritoneal transport pattern according to the peritoneal equilibration test. Perit Dial Int 2002 Mar; 22(2): 229–33
- Fredd S. Medical review [7.5% icodextrin peritoneal dialysis solution] [online]. Available from URL: http://www.fda.gov/ohrms/dockets/ac/01/briefing3775bl_07_Medical%20Review.pdf [Accessed 2003 May 21]
- Posthuma N, ter Wee PM, Donker AJM, et al. Assessment of the effectiveness, safety, and biocompatibility of icodextrin in automated peritoneal dialysis. The Dextrin in APD in Amsterdam (DIANA) Group. Perit Dial Int 2000; 20 Suppl. 2: S106–13
- Woodrow G, Oldroyd B, Stables G, et al. Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis. Nephrol Dial Transplant 2000 Jun; 15(6): 862–6 CrossRef
- Konings CJAM, Kooman JP, Schonck M, et al. Effect of icodextrin on volume status, blood pressure and echocardi-ographic parameters: a randomized study. Kidney Int 2003; 63: 1556–63 CrossRef
- Davies SJ, Woodrow G, Donovan K, et al. Icodextrin improves fluid balance in peritoneal dialysis patients: results of a randomized controlled trial [abstract]. Perit Dial Int 2002; 22(1): 32
- Davies SJ, Woodrow G, Plum J, et al. Longitudinal changes in body composition and blood pressure: results from the Icodextrin Fluid Balance Study [abstract]. Perit Dial Int 2003; 23 Suppl. 1: S18
- Moberly JB, Mujais S, Gehr T, et al. Pharmacokinetics of icodextrin in peritoneal dialysis patients. Kidney Int 2002 Oct; 62 Suppl. 81: S23–33 CrossRef
- Amici G, Orrasch M, Da Rin G, et al. Hyperinsulinism reduction associated with icodextrin treatment in continuous ambulatory peritoneal dialysis patients. Adv Perit Dial 2001; 17: 80–3
- Bajo MA, Selgas R, del Peso G, et al. Use of icodextrin for diurnal exchange in patients undergoing automatic peritoneal dialysis. Comparison with glucose solutions [in Spanish]. Nefrologia 2002; 22(4): 348–55
- Mistry CD, Gokal R, Peers E. A randomized multicenter clinical trial comparing isosmolar icodextrin with hyperosmolar glucose solutions in CAPD. MIDAS Study Group. Kidney Int 1994 Aug; 46(2): 496–503
- Bredie SJH, Bosch FH, Demacker PNM, et al. Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism. Perit Dial Int 2001 May-2001 30; 21(3): 275–81
- Plum J, Gentile S, Verger C, et al. Efficacy and safety of a 7.5% icodextrin peritoneal dialysis solution in patients treated with automated peritoneal dialysis. Am J Kidney Dis 2002 Apr; 39(4): 862–71 CrossRef
- Guerrero A, Montes R, Martin-Herrera C, et al. Clinical experience with icodextrin. Multicenter study [in Spanish]. Nefrologia 2001; 21(6): 574–80
- Guastoni C, Renzetti G, Barzaghi V, et al. Effects of icodextrin on lipid profiles in patients on ambulatory peritoneal dialysis (CAPD) [abstract]. Perit Dial Int 2003; 23 Suppl. 1: S44
- Cooker LA, Holmes CJ, Hoff CM. Biocompatibility of icodextrin. Kidney Int 2002 Oct; 62 Suppl. 81: S34–45 CrossRef
- Posthuma N, ter Wee PM, Niessen H, et al. Amadori albumin and advanced glycation end-product formation in peritoneal dialysis using icodextrin. Perit Dial Int 2001 Jan; 21(1): 43–51
- Ueda Y, Miyata T, Goffin E, et al. Effect of dwell time on carbonyl stress using icodextrin and amino acid peritoneal dialysis fluids. Kidney Int 2000 Dec; 58(6): 2518–24 CrossRef
- Barre DE, Chen C, Cooker L, et al. Decreased in vitro formation of AGEs with Extraneal solution compared to dextrose-containing peritoneal dialysis solutions. Adv Perit Dial 1999; 15: 12–6
- Dawnay ABSJ, Millar DJ. Glycation and advanced glycation end-product formation with icodextrin and dextrose. Perit Dial Int 1997 Jan; 17(1): 52–8
- Lee JH, Reddy DK, Saran R, et al. Peritoneal accumulation of advanced glycosylation end-products in diabetic rats on dialysis with icodextrin. Perit Dial Int 2000; 20 Suppl. 5: S39–47
- De Vriese AS, Mortier S, Lameire NH. Glucotoxicity of the peritoneal membrane: the case for VEGF. Nephrol Dial Transplant 2001; 16(12): 2299–302 CrossRef
- Ho-dac-Pannekeet MM, Weiss MF, de Waart DR, et al. Analysis of non enzymatic glycosylation in vivo: impact of different dialysis solutions. Perit Dial Int 1999; 19 Suppl. 2: S68–74
- Brown EA, Davies SJ, Heimbürger O, et al. Adequacy targets can be met in anuric patients by automated peritoneal dialysis: baseline data from EAPOS. Perit Dial Int 2001; 21 Suppl. 3: S133–7
- Posthuma N, ter Wee PM, Donker AJ, et al. Serum disaccha-rides and osmolality in CCPD patients using icodextrin or glucose as daytime dwell. Perit Dial Int 1997 Nov; 17(6): 602–7
- de Boer AW, Schroder CH, van Vliet R, et al. Clinical experience with icodextrin in children: ultrafiltration profiles and metabolism. Pediatr Nephrol 2000 Nov; 15(1–2): 21–4 CrossRef
- Wang R, Moberly JB, Martis L, et al. A rapid assay for icodextrin determination in plasma and dialysate. Adv Perit Dial 2002; 18: 91–5
- Davies DS. Kinetics of icodextrin. Perit Dial Int 1994; 14 Suppl. 2: S45–50
- Mistry CD, Gokal R. Icodextrin in peritoneal dialysis: early development and clinical use. Perit Dial Int 1994; 14 Suppl. 2: S13–21
- Woodrow G, Stables G, Oldroyd B, et al. Comparison of icodextrin and glucose solutions for the daytime dwell in automated peritoneal dialysis. Nephrol Dial Transplant 1999 Jun; 14(6): 1530–5 CrossRef
- Wolfson M, Ogrinc F, Mujais S. Review of clinical trial experience with icodextrin. Kidney Int 2002 Oct; 62 Suppl. 81: S46–52 CrossRef
- Gokal R. Peritoneal dialysis. Prevention and control of infection. Drugs Aging 2000 Oct; 17(4): 269–82 CrossRef
- Van Biesen W, Veys N, Vanholder R, et al. Peritoneal-dialysis-related peritonitis: the art of rope-dancing. Nephrol Dial Transplant 2002; 17(11): 1878–82 CrossRef
- Gokal R, Mistry CD, Peers EM. Peritonitis occurrence in a multicenter study of icodextrin and glucose in CAPD. MIDAS Study Group. Perit Dial Int 1995 Jul; 15(6): 226–30
- Posthuma N, ter Weel PM, Donker AJ, et al. Icodextrin use in CCPD patients during peritonitis: ultrafiltration and serum disaccharide concentrations. Nephrol Dial Transplant 1998 Sep; 13(9): 2341–4 CrossRef
- Divino Filho JC. A multicenter analysis shows that Extraneal may contribute to better technique and patient survival [abstract]. Perit Dial Int 2003; 23 Suppl. 1: S19
- Guo A, Wolfson M, Holt R. Early quality of life benefits of icodextrin in peritoneal dialysis. Kidney Int 2002 Oct; 62 Suppl. 81: S72–9 CrossRef
- Wilkie ME, Plant MJ, Edwards L, et al. Icodextrin 7.5% dialysate solution (glucose polymer) in patients with ultrafiltration failure: extension of CAPD technique survival. Perit Dial Int 1997 Jan-1997 28; 17(1): 84–7
- Johnson DW, Arndt M, O’Shea A, et al. Icodextrin as salvage therapy in peritoneal dialysis patients with refractory fluid overload. BMC Nephrol 2001; 2(1): 2 CrossRef
- Peers EM, Scrimgeour AC, Haycox AR. Cost-containment in CAPD patients with ultrafiltration failure. Clin Drug Invest 1995 Jul; 10: 53–8
- Johnson DW, Vincent K, Blizzard S, et al. Cost savings from peritoneal dialysis therapy time extension using icodextrin. Adv Perit Dial In press
- MacGinley R, Cooney K, Alexander G, et al. Relapsing culture-negative peritonitis in peritoneal dialysis patients exposed to icodextrin solution. Am J Kidney Dis 2002 Nov; 40(5): 1030–5 CrossRef
- EkartR, Pecovnik-Balon B, Dvorsak B, et al. Sterile peritonitis after administration of icodextrin [in Serbo-Croatian (Roman)]. Acta Med Croatica 2002; 56(4-5): 185–7
- Goffin E, Scheiff JM. Transient sterile chemical peritonitis in a CAPD patient using icodextrin [letter]. Perit Dial Int 2002 Jan; 22(1): 90–1
- Williams PF, Foggensteiner L. Sterile/allergic peritonitis with icodextrin in CAPD patients [letter]. Perit Dial Int 2002 Jan; 22(1): 89–90
- Fiedler R, Schneider I, Buchmann J, et al. Does peritoneal dialysis predispose a diabetic patient to icodextrin-induced peritonitis? [letter]. Nephrol Dial Transplant 2002 Sep; 17(9): 1708–9 CrossRef
- Heering P, Brause M, Plum J, et al. Peritoneal reaction to icodextrin in a female patient on CAPD [letter]. Perit Dial Int 2001 May; 21(3): 321–2
- Reichel W, Schulze B, Dietze J, et al. A case of sterile peritonitis associated with icodextrin solution [letter]. Perit Dial Int 2001 Jul; 21(4): 414–5
- Montagnac R, Slingeneyer A, Schillinger F. Aseptic peritonitis: role of icodextrin [letter]. Nephrol Dial Transplant 2001 Feb; 16(2): 435–6 CrossRef
- Del Rosso G, Di Liberate L, Perilli A, et al. A new form of acute adverse reaction to icodextrin in a peritoneal dialysis patient [letter]. Nephrol Dial Transplant 2000 Jun; 15(6): 927–8 CrossRef
- Pinerolo MC, Porri MT, D’ Amico G. Recurrent sterile peritonitis at onset of treatment with icodextrin solution. Perit Dial Int 1999; 19(5): 491–2
- Boer WH, Vos PF, Fieren MWJA. Culture-negative peritonitis associated with the use of icodextrin-containing dialysate in twelve patients treated with peritoneal dialysis. Perit Dial Int 2003; 23: 33–8
- Gokal R. Icodextrin-associated sterile peritonitis. Perit Dial Int 2002 Jul; 22(4): 445–8
- Kanny G, Durand PY, Beaudouin E, et al. Hypersensitivity to icodextrin. Allergy 2002 Jan; 57(1): 60–1 CrossRef
- Valance A, Lebrun-Vignes B, Descamps V, et al. Icodextrin cutaneous hypersensitivity: report of 3 psoriasiform cases. Arch Dermatol 2001 Mar; 137(3): 309–10
- Al-Hoqail IA, Crawford RI. Acute generalized exanthematous pustulosis induced by icodextrin [letter]. Br J Dermatol 2001 Dec; 145(6): 1026–7 CrossRef
- Goldsmith D, Jayawardene S, Sabharwal N, et al. Allergic reactions to the polymeric glucose-based peritoneal dialysis fluid icodextrin in patients with renal failure [letter]. Lancet 2000 Mar 11; 355(9207): 897 CrossRef
- Fletcher S, Stables GA, Turney JH. Icodextrin allergy in a peritoneal dialysis patient. Nephrol Dial Transplant 1998 Oct; 13(10): 2656–8 CrossRef
- Wilkie ME, Brown CB. Polyglucose solutions in CAPD. Perit Dial Int 1997; 17 Suppl. 2: S47–50
- Lam-Po-Tang MK, Bending MR, Kwan JT. Icodextrin hypersensitivity in a CAPD patient. Perit Dial Int 1997; 17(1): 82–4
- Divino Fiho JC. Allergic reactions to icodextrin in patients with renal failure [letter]. Lancet 2000 Apr 15; 355(9212): 1364–5
- Gradden CW, Ahmad R, Bell GM. Peritoneal dialysis: new developments and new problems. Diabet Med 2001 May; 18(5): 360–3 CrossRef
- Wens R, Taminne M, Devriendt J, et al. A previously undescribed side effect of icodextrin: overestimation of glycemia by glucose analyzer [abstract]. Perit Dial Int 1998 Nov; 18(6): 603–9
- Janssen W, Harff G, Caers M, et al. Positive interference of icodextrin metabolites in some enzymatic glucose methods [letter]. Clin Chem 1998 Nov; 44(11): 2379–80
- Mehmet S, Quan G, Thomas S, et al. Important causes of hypoglycaemia in patients with diabetes on peritoneal dialysis. Diabet Med 2001 Aug; 18(8): 679–82 CrossRef
- Oyibo SO, Pritchard GM, McLay L, et al. Blood glucose overestimation in diabetic patients on continuous ambulatory peritoneal dialysis for end-stage renal disease. Diabet Med 2002 Aug; 19(8): 693–6 CrossRef
- Wang R, Leesch V, Turner P, et al. Kinetic analysis of icodextrin interference with serum amylase assays. Adv Perit Dial 2002; 18: 96–9
- Schoenicke G, Grabensee B, Plum J. Dialysis with icodextrin interferes with measurement of serum a-amylase activity. Nephrol Dial Transplant 2002 Nov; 17(11): 1988–92 CrossRef
- Anderstam B, Garcia-Lopez E, Heimburger O, et al. Determination of alpha-amylase activity in serum and dialysate from patients using icodextrin-based peritoneal dialysis fluid. Perit Dial Int 2003; 23(2): 146–50
- Burke RA, Hughes G, Moberly JB. Lack of interference of icodextrin on creatinine measurements. Adv Perit Dial 1999; 15: 234–7
- Margetts PJ, Churchill DN. Acquired ultrafiltration dysfunction in peritoneal dialysis patients. J Am Soc Nephrol 2002; 13(11): 2787–94
- Gokal R, Hutchison A. Dialysis therapies for end-stage renal failure. Semin Dial 2002; 15(4): 220–6 CrossRef
- Van Biesen W, Vanholder R, Lamiere N. The role of peritoneal dialysis as the first-line renal replacement therapy. Perit Dial Int 2000; 20: 375–83
- Vale L, Cody J, Wallace S, et al. Continuous ambulatory peritoneal dialysis (CAPD) versus hospital or home haemodialysis for end-stage renal disease in adults. Cochrane Database Syst Rev 2003; 1: CD003963
- Valderrabano F, Jofre R, Lopez-Gomez JM. Quality of life in end-stage renal disease patients. Am J Kidney Dis 2001 Sep; 38(3): 443–64 CrossRef
- Chung SH, Stenvinkel P, Bergström J, et al. Biocompatibility of new peritoneal dialysis solutions: what can we hope to achieve? Perit Dial Int 2000; 20 Suppl. 5: S57–67
- Gokal R, Figueras M, Olle A, et al. Outcomes in peritoneal dialysis and haemodialysis: a comparative assessment of survival and quality of life. Nephrol Dial Transplant 1999; 14 Suppl. 6: 24–30 CrossRef
- Blake PG. Integrated end-stage renal disease care: the role of peritoneal dialysis. Nephrol Dial Transplant 2001; 16 Suppl. 5: 61–6 CrossRef
- Burkart JM. Peritoneal dialysis should be considered as the first line of renal replacement therapy for most ESRF patients. Blood Purif 2001; 19(2): 179–84 CrossRef
- Van Biesen W, Vanholder RC, Veys N, et al. An evaluation of an integrative care approach for end-stage renal disease patients. J Am Soc Nephrol 2000; 11(1): 116–25
- Coles GA, Williams JD. What is the place of peritoneal dialysis in the integrated treatment of renal failure? Kidney Int 1998; 54(6): 2234–40 CrossRef
- Thodis E, Passadakis P, Vargemezis V, et al. Peritoneal dialysis: better than, equal to, or worse than hemodialysis? Data worth knowing before choosing a dialysis modality. Perit Dial Int 2001; 21(1): 25–35
- Heimburger O, Wang T, Lindholm B. Alterations in water and solute transport with time on peritoneal dialysis. Perit Dial Int 1999; 19 (Suppl. 2): S83–90
- Kawaguchi Y. National comparisons: optimal peritoneal dialysis outcomes in Japanese patients. Perit Dial Int 1999; 19 (Suppl. 2): S9–16
- Lameire N, Bernaert P, Lambert MC, et al. Cardiovascular risk factors and their management in patients on continuous ambulatory peritoneal dialysis. Kidney Int 1994 Dec; 46 Suppl. 48: S31–8
- Pecoits-Filho R, Mujais S, Lindholm B. Future of icodextrin as an osmotic agent in peritoneal dialysis. Kidney Int 2002 Oct; 62 Suppl. 81: S80–7 CrossRef
- Cancarini G. Strategy for preventing peritoneal dialysis failure. Contrib Nephrol 2001; (131): 114–24
- Garcia-Lopez E, Lindholm B, Tranaeus A. Biocompatibility of new peritoneal dialysis solutions: clinical experience. Perit Dial Int 2000; 20 Suppl. 5: S48–56
- Holmes CJ, Shockley TR. Strategies to reduce glucose exposure in peritoneal dialysis patients. Perit Dial Int 2000; 20 Suppl. 2: S37–41
- Krediet R, Mujais S. Use of icodextrin in high transport ultrafiltration failure. Kidney Int 2002 Oct; 62 Suppl. 81: S53–61 CrossRef
- Riegel W, Brown EA, Davies SJ, et al. Can anuric patients be successfully treated by APD? Results of EAPOS (European APD Outcome Study) [abstract no. W698]. Nephrol Dial Transplant 2003; 18 Suppl. 4: 771
- Van Biesen W, Veys N, Vanholder R, et al. New concepts in peritoneal dialysis: new wine in old barrels? Artif Organs 2003; 27(5): 398–405 CrossRef
- Queffeulou G, Bernard M, Vrtovsnik F, et al. Severe cutaneous hypersensitivity requiring permanent icodextrin withdrawal in a CAPD patient. Clin Nephrol 1999 Mar; 51(3): 184–6
Volume 63, Issue 19 , pp 2079-2105
- Cover Date
- Print ISSN
- Online ISSN
- Springer International Publishing
- Additional Links
- Industry Sectors