Davies, SJ, Zhao, J, McCullough, KP, Kim, Y-L, Wang, AY-M, Badve, SV, Mehrotra, R, Kanjanabuch, T, Kawanishi, H, Robinson, BM, Pisoni, R and Perl, J (2022) International Icodextrin Use and association with peritoneal membrane function, fluid removal, patient and technique survival. Kidney360, 3 (5). pp. 872-882. ISSN 2641-7650

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Background: Icodextrin has been shown in randomized controlled trials to benefit fluid management in peritoneal dialysis (PD). We describe international icodextrin prescription practices and their relationship to clinical outcomes. Methods We analyzed data from the prospective, international PDOPPS, from Australia/New Zealand, Canada, Japan, the United Kingdom, and the United States. Membrane function and 24-hour ultrafiltration according to icodextrin and glucose prescription was determined at baseline. Using an instrumental variable approach, Cox regression, stratified by country, was used to determine any association of icodextrin use to death and permanent transfer to hemodialysis (HDT), adjusted for demographics, comorbidities, serum albumin, urine volume, transplant waitlist status, PD modality, center size, and study phase. Results Icodextrin was prescribed in 1986 (35%) of 5617 patients, .43% of patients in all countries, except in the United States, where it was only used in 17% and associated with a far greater use of hypertonic glucose. Patients on icodextrin had more coronary artery disease and diabetes, longer dialysis vintage, lower residual kidney function, faster peritoneal solute transfer rates, and lower ultrafiltration capacity. Prescriptions with or without icodextrin achieved equivalent ultrafiltration (median 750 ml/d [interquartile range 300-1345 ml/d] versus 765 ml/d [251-1345 ml/d]). Icodextrin use was not associated with mortality (HR51.03; 95% CI, 0.72 to 1.48) or HDT (HR 1.2; 95% CI, 0.92 to 1.57). Conclusions There are large national and center differences in icodextrin prescription, with the United States using significantly less. Icodextrin was associated with hypertonic glucose avoidance but equivalent ultrafiltration, which may affect any potential survival advantage or HDT.

Item Type: Article
Additional Information: The final version of this article and all relevant information related to it, including copyrights, can be found on the publisher website at; https://kidney360.asnjournals.org/content/early/2022/03/01/KID.0006922021
Uncontrolled Keywords: diabetes and the kidney; dialysis modality transfer; icodextrin; patient survival; peritoneal dialysis; peritoneal membrane function
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC902 Nephrology
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 11 Mar 2022 13:18
Last Modified: 21 Jul 2022 13:46
URI: https://eprints.keele.ac.uk/id/eprint/10701

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