Background: The use of dextrose-containing solutions in peritoneal dialysis (PD) is thought to be associated with glucose-related toxicity both to the peritoneal membrane and systemically. There has, therefore, been considerable interest in minimizing the use of dextrose exposure during PD. The present study was designed to explore the use of icodextrin in patients with high/high-average transporter characteristics for two exchanges per day to minimize glucose exposure. Methods: We performed a 6-month prospective cohort study using two icodextrin exchanges per day in a group of high/high-average transporters maintained on automated PD. Icodextrin levels, serum sodium levels, and glucose exposure were measured at baseline, 3 and 6 months. Results: Nine patients completed the study protocol. While the total volume of PD solution remained the same, there was a reduction in mean glucose exposure from a baseline mean value of 410 ± 75 to 275 ± 57 g/day at 3 months and 300 ± 75 g/day at 6 months. Serum icodextrin levels rose from a baseline mean of 345 ± 145 to 615 ± 120 mg/dl at 3 months and 620 ± 108 mg/dl at 6 months. Serum sodium levels remained stable. Conclusion: The use of two (double) icodextrin exchanges in high/high-average transporters on PD can contribute to reduction in glucose exposure for patients maintained on automated PD and appears to be safe.

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