Dialysis
Figure 2: Kaplan–Meier Plots for All-cause Mortality (A), Cardiovascular Mortality (B), Infectious Death (C) and Technique Failure (D) in a Matched Cohort of Patients Treated with Icodextrin or without Icodextrin (Propensity Score Analysis)
A 0.4 0.3 Non-icodextrin 0.2 Icodextrin 0.1 p= 0.004 0.0
No at risk Icodextrin
Non-icodextrin C 0.20 0.15 p = 0.204 0.10 Non-icodextrin 0.05 Icodextrin 0.00
No at risk Icodextrin
Non-icodextrin 0
640 640
12243648 Months
588 565
410 379
192 196
56 63
No at risk Icodextrin
Non-icodextrin 0.00 0
640 640
0.05 Icodextrin P = 0.018
12243648 Months
590 574
414 387
198 196
54 63
Source: Han SH, Ahn SV, Yun JY, et al., Effects of icodextrin on patient survival and technique success in patients undergoing peritoneal dialysis, Nephrol Dial Transplant, 2011 [Epub ahead of print], by permission of Oxford University Press.
patients treated with icodextrin was significantly lower than that of glucose-treated patients but also that the annual mortality rate was 6.6 % in icodextrin-treated patients versus 13.5 % in glucose-treated patients (p<0.0001) in this cohort. This observation was recently confirmed in a large propensity score-matched Korean patient population (see Figure 2).45
Likewise, improved survival of the PD
technique was recently reported during icodextrin treatment in diabetic patients.46
Amino Acid-based Solutions
In animal studies, it has been clearly demonstrated that amino acid-based PDF results in a better functionally and morphologically preserved integrity of the peritoneal membrane compared with glucose-based PDF.8,47
Soon after becoming available, it became
apparent that the 1 % amino acid-based solution had a similar peritoneal transport and ultrafiltration capacity to 1.36 % glucose-based solutions.48,49
Much attention has been paid to the
nutritional aspects of amino acid-based solutions. In some studies, the dialysis regimen was changed by replacing one exchange of glucose-based solution by an exchange of amino acid-based solutions. This regimen resulted in improvements in various nutritional parameters such as serum albumin, prealbumin and amino
50 acid profiles50–53
mid-arm muscle circumference;55,56 malnourished patients in particular.55,57–60
and in increases in muscle amino acid uptake54 these improvements were seen in
and 0.10 0
640 640
12243648 Months
605 591
424 397
199 205
57 64
0.00
No at risk Icodextrin
Non-icodextrin D 0.20 0.15 Non-icodextrin 0
640 640
0.05 p= 0.072
12243648 Months
598 579
420 392
197 199
55 62
0.10 Icodextrin B 0.20 0.15 Non-icodextrin
demonstrated improved net protein balance in automated peritoneal dialysis (APD)-treated patients who were treated with a mixture of amino acids and glucose PDF. Similarly, it was demonstrated that mixing amino acids with glucose during APD in children resulted in improved amino acid utilisation for protein synthesis.62
For nutritional purposes, replacing a glucose-based exchange by amino acids may not be the optimal strategy, but mixing amino acids with glucose in the same exchange may be a better approach. Tjiong et al.61
Thus exchanges with combined amino acid and glucose solutions might have better outcomes, but long-term studies are lacking. Some other benefits of amino acid-based solutions have been described. Improved glucose and lipid metabolism has been reported with an amino acid-containing regimen,31 could not be confirmed in another study.32
although this However, administration
of amino acids was shown to impair forearm reactive hyperaemia.63 So far, however, extended use of PD regimens containing amino acid exchanges has been proven to be safe but without improvement in cardiovascular mortality.57,60,64
EUROPEAN NEPHROLOGY
Proportion with infectious death
Proportion with all-cause death
Proportion with technique failure
Proportion with cardiovascular death
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