Peritoneal defense using icodextrin or glucose for daytime dwell in CCPD patients
N Posthuma, PM Ter Wee… - Peritoneal dialysis …, 1999 - journals.sagepub.com
N Posthuma, PM Ter Wee, AJM Donker, HAT Dekker, PL Oe, HA Verbrugh
Peritoneal dialysis international, 1999•journals.sagepub.comObjective To investigate peritoneal defense during icodextrin use in continuous cyclic
peritoneal dialysis (CCPD). Design In an open, prospective, 2-year follow-up study, CCPD
patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long daytime
dwell. Setting University hospital and teaching hospital. Patients Both established and
patients new to CCPD were included. A life expectancy of more than 2 years, a stable
clinical condition, and written informed consent were necessary before entry. Patients aged …
peritoneal dialysis (CCPD). Design In an open, prospective, 2-year follow-up study, CCPD
patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long daytime
dwell. Setting University hospital and teaching hospital. Patients Both established and
patients new to CCPD were included. A life expectancy of more than 2 years, a stable
clinical condition, and written informed consent were necessary before entry. Patients aged …
Objective
To investigate peritoneal defense during icodextrin use in continuous cyclic peritoneal dialysis (CCPD).
Design
In an open, prospective, 2-year follow-up study, CCPD patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long daytime dwell.
Setting
University hospital and teaching hospital.
Patients
Both established and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18 years, those who had peritonitis in the previous month, and women of childbearing potential, unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients (19 Glu, 19 Ico) started the study. The median follow-up was 16 and 17 months for Glu and Ico respectively (range 0.5 – 25 months and 5 – 25 months, respectively).
Outcome Measures
Peritoneal defense characteristics and peritoneal dialysis-related infections were recorded every 3 months.
Results
Total peritoneal white cell count tended to decrease over time in both groups. After 1 year, absolute numbers and percentages of effluent peritoneal macrophages (PMΦs) were significantly higher in Ico than in Glu patients; this difference in the percentage persisted after 2 years. Percentage of mesothelial cells increased over time in Ico patients. The phagocytic capacity of PMΦs decreased over time, resulting in a borderline significant difference for coagulase-negative staphylococci (p = 0.05) and a significant difference for Escherichia coli (p < 0.05) phagocytosis in favor of Ico patients. PMΦ oxidative metabolism remained stable over time without a difference between the groups. PMΦ cytokine production and effluent opsonic capacity also remained stable over time. Finally, 16 peritonitis episodes in Glu and 14 in Ico patients occurred. Glucose patients had 37 and Ico patients 32 exit-site infections during the study.
Conclusion
CCPD patients using Ico did equally as well as Glu-treated patients with respect to clinical infections and most peritoneal defense characteristics. However, in a few peritoneal defense tests, Ico-treated patients did better.
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