A Medical Clinical White Paper | April 2018
Authors: Gopa B. Green, MD and Graham Abra, MD
Icodextrin 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). Iso-osmotic 7.5% icodextrin solution (Extraneal) induces transcapillary ultrafiltration (UF) by colloidal osmotic pressure and can achieve greater UF over an 8-16 hour long dwell.
Randomized clinical trials that examine the relationship between membrane transport characteristics and net UF demonstrate that the greatest improvements in UF over the long dwell with icodextrin are in patients with high and high-average membrane transport. Icodextrin use carries the risk of interference with blood glucose monitoring, measuring amylase levels, cutaneous reactions, and sterile peritonitis. In additional, icodextrin is more expensive than dextrose based solutions and attention to appropriate clinical use is an important component of responsible resource use.
We hope you find this topic as interesting as we do and look forward to any insights you have regarding its use in your own practice.