Two icodextrin exchanges per day in peritoneal dialysis patients with ultrafiltration failure: one center’s experience and review of the literature

At present, only one exchange of an icodextrin-based solution is recommended to increase peritoneal ultrafiltration (UF) during long-dwell exchanges in peritoneal dialysis (PD) patients with impaired UF.To review our experience with two icodextrin exchanges per day on net UF and body weight in PD patients with poor UF.Data were analyzed on nine patients with poor UF on chronic PD who were given two icodextrin exchanges per day for 6 months and had various clinical and biochemical parameters assessed monthly.Administration of icodextrin twice daily reduced the body weight in six of nine patients by an average of 2.9 ± 1.2 kg, a reduction that was maintained throughout the study; two patients gained 0.5 kg; and, in one patient, the measurements were inadequate. Mean blood pressure was reduced. Mean serum creatinine increased slightly. Serum sodium levels decreased from a mean baseline level of 134 ± 3 to 132 ± 4 mmol/L at three and six months. Among the diabetics in this group, average daily insulin requirements were 44 ± 35 units/day at baseline and 40 ± 23 units/day after 6 months. Hb1Ac levels remained stable throughout the study period.The use of two icodextrin exchanges per day reduced body weight in six of the nine patients and appeared to be safe. Long-term prospective studies are needed to assess the contribution of twice-daily icodextrin to the management of peritoneal dialysis patients with ultrafiltration failure and its long-term safety.