Background: Icodextrin, an effective osmotic substance that has been proposed as an alternative agent for peritoneal dialysis induces ultrafiltration over long dwells. This study examines the peritoneal transport after exposure to Icodextrin in rats. Methods: Animals were divided in 4 groups and injected daily for 30 days with Icodextrin 7.5 % (n = 14), Glucose 4.25 % (n = 19) or glucose 4.25% plus Icodextrin 7.5 % (n = 13). Rats of the control group (n = 15) were not exposed. A 4-hour permeability study was performed using glucose at days 1, 30 and 60. At days 2, 31 and 61 the same animals were injected with Icodextrin. Results: Slopes of effluent sodium at day 30 were significantly higher (p < 0.001) in the glucose (0.006 ± 0.016), Icodextrin (0.013 ± 0.014) and mixed groups (0.012 ± 0.017) than in the control group (–0.041 ± 0.021). Urea D/P ratio was not significantly different in the 4 groups. After 30 days, glucose effluent levels were significantly lower (p < 0.001) in the glucose (701 ± 278 mg/dl), Icodextrin (552 ± 209 mg/dl) and mixed groups (587 ± 344 mg/dl) than in control rats (1519 ± 413 mg/dl). Effluent protein (mg/l) in the mixed group (1,555 ± 357) was significantly higher (p < 0.001) than control (376 ± 33), glucose (1,015 ± 232) and Icodextrin (765 ± 75) groups at day 30. Conclusion: The long-term use of Icodextrin does not affect small molecule transport, but induces changes in the peritoneal protein excretion, especially when Icodextrin and glucose are injected together.

1.
Rubin J, Klein E, Jones Q, Planch A, Bower J: Evaluation of a polymer dialysate. Trans Am Soc Artif Intern Organs 1983;29:62–65.
2.
Higgins JT, Gross ML, Somani P: Patient tolerance and dialysis effectiveness of a glucose polymer-containing peritoneal dialysis solution. Perit Dial Bull 1984;4:S131-S133.
3.
Mistry CD, Mallick NP, Gokal R: Ultrafiltration with an isosmotic solution during long peritoneal dialysis exchanges. Lancet 1987;ii:178–182.
4.
Peers E: Icodextrin plus glucose combinations for use in CAPD. Perit Dial Int 1997;17(suppl 2):S68–S69.
5.
Mistry CD, Gokal R, Peers EM, the MIDAS Study Group: A randomized multicenter clinical trial comparing isosmolar Icodextrin with hyperosmolar glucose solutions in CAPD. Kidney Int 1994;46:496–503.
6.
Posthuma N, Ter Wee PM, Verbrugh HA, Oe PL, Peers E, Sayers J, Donker AJM: Icodextrin instead of glucose during the daytime dwell in CCPD increases ultrafiltration and 24-h dialysate creatinine clearance. Nephrol Dial Transplant 1997;12:550–553.
7.
Woodrow G, Stables G, Oldroyd B, Gibson J, Turney JH, Brownjohn AM: Comparison of icodextrin and glucose solutions for the daytime dwell in automated peritoneal dialysis. Nephrol Dial Transplant 1999;14:1530–1535.
8.
Peers E, Gokal R: Icodextrin: Overview of clinical experience. Perit Dial Int 1997;17:22–26.
9.
Peers EM, Scrimgeour AC, Hacycox AR: Cost-containment in CAPD patients with ultrafiltration failure. Clin Drug Invest 1995;10:53–58.
10.
Stein A, Peers E, Hattersley J, Feehally J, Walls J: Clinical experience with Icodextrin in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 1994;14(suppl 2):S51–S54.
11.
Wilkie ME, Plant MJ, Edwards L, Brown CB: Icodextrin 7.5% dialysate solution (glucose polymer) in patients with ultrafiltration failure: extension of CAPD technique survival. Perit Dial Int 1997;17:84–87.
12.
Thomas S, Schenk U, Fischer FF, Mettang T, Passlick-Deetjen J, Kuhlmann U: In vitro effects of glucose polymer-containing peritoneal dialysis fluids on phagocytic activity. Am J Kidney Dis 1997;29:246–253.
13.
Liberek T, Topley N, Mistry CD, Coles GA, Morgan T, Quirk RA, Williams JD: Cell function and viability in glucose polymer peritoneal dialysis fluids. Perit Dial Int 1997;13:104–111.
14.
Topley N, Liberek T, Mistry C, Coles GA, Williams JD: Cell function, viability, and Icodextrin. Perit Dial Int 1994;14(suppl 2):S28–S32.
15.
Posthuma N, ter Wee PM, Donker AJM, Oe PL, Verbrugh HA, Peers E: Disaccharide (‘total maltose’) levels in APD patients using Icodextrin or glucose (abstract). Perit Dial Int 1996;16:S77.
16.
Posthuma N, ter Wee PM, Donker AJM, Peers, EM, Oe PL, Verbrugh HA: Icodextrin use in CCPD patients during peritonitis: Ultrafiltration and serum disaccharide concentrations. Nephrol Dial Transplant 1998;13:2341–2344.
17.
Ho-dac-Pannekeet MM, Schouten N, Langendijk MJ, Hiralall JK, de Waart DR, Struijk DG, Krediet RT: Peritoneal transport characteristics with glucose polymer based dialysate. Kidney Int 1996;50:979–986.
18.
Krediet RT, Douma CE, Ho-dac-Pannekeet MM, Imholz ALT, Zemel D, Zweers MM, Smit A, Struijk DG: Impact of different dialysis solutions on solute and water transport. Perit Dial Int 1997;17(suppl 2):S17–S26.
19.
Krediet RT, Ho-dac-Pannekeet MM, Imholz ALT, Struijk DG: Icodextrin’s effects on peritoneal transport. Perit Dial Int 1997;17:35–41.
20.
Wang T, Heimbürger, Cheng HH, Bergström J, Lindholm B: Peritoneal fluid and solute transport with different polyglucose formulations. Perit Dial Int 1998;18:193–203.
21.
Posthuma N, Verbrugh HA, Donker AJ, van Dorp W, Dekker HA, Peers EM, Oe PL, ter Wee PM: Peritoneal kinetics and mesothelial markers in CCPD using icodextrin for daytime dwell for two years. Perit Dial Int 2000;20:174–180.
22.
Institute of Laboratory Animal Resources: Guide for the Care and Use of Laboratory Animals. DHEW Publ No (NIH) 72–73. Washington, National Institutes of Health, 1972.
23.
Waniewski J, Heimburger O, Werynski A, Lindholm B: Aqueous solute concentrations and evaluation of mass transport coefficients in peritoneal dialysis. Nephrol Dial Transplant 1992;7:50–56.
24.
Glantz SA: Primer of Biostatistics. New York, McGraw-Hill, 1992, pp 155–349.
25.
Mistry CD, Gokal R: Can ultrafiltration occur with a hypo-osmolar solution in peritoneal dialysis? Clin Sci 1993;85:495–500.
26.
Mistry CD, Gokal R: Icodextrin in peritoneal dialysis: Early development and clinical use. Perit Dial Int 1994;14:S13–S21.
27.
Burke RA, Shockley TR: Direct determination of polyglucose (PG) metabolites in plasma using HPAE-PAD (abstract). Perit Dial Int 1996;16:S90.
28.
Weser E, Sleisenger MH: Metabolism of circulating disaccharides in man and the rat. J Clin Invest 1967;46:499–505.
29.
Jolley RL, Warren KS, Scott CD, Jainchill JL, Freeman ML: Carbohydrates in normal urine and blood serum as determined by high-resolution column chromatography. Am J Clin Pathol 1970;53:793–802.
30.
Imholtz ALT, Brown CB, Koomen GCM, Arisz L, Krediet RT: The effect of glucose polymers on water removal and protein clearances during CAPD. Adv Perit Dial 1993;9:25–30.
31.
Blumenkrantz MJ, Roberts CE, Card B, Coburn JW, Kopple JD: Nutritional management of the adult patient undergoing peritoneal dialysis. J Am Diet Assoc 1978;73:251–256.
32.
Jorres A, Gahl GM, Topley N, Neubauer A, Ludat K, Muller C, Passlick- Deetjen J: In-vitro biocompatibility of alternative CAPD fluids: Comparison of bicarbonate-buffered and glucose-polymer-based solutions. Nephrol Dial Transplant 1994;9:785–790.
33.
de Fijter CW, Verbrugh HA, Oe LP, Heezius E; Donker AJ, Verhoef J, Gokal R: Biocompatibility of a glucose-polymer-containing peritoneal dialysis fluid. Am J Kidney Dis 1993;21:411–418.
34.
Dawnay AB, Millar DJ: Glycation and advanced glycation end-product formation with icodextrin and dextrose. Perit Dial Int 1997;17:52–58.
35.
Barre DE, Chen C, Cooker L, Moberly JB: Decreased in vitro formation of AGEs with extraneal solution compared to dextrose-containing peritoneal dialysis solutions. Adv Perit Dial 1999;5:12–16.
36.
Ho-dac-Pannekeet MM, Weiss-MF, de Waart DR, Erhard P, Hiralall JK; Krediet RT: Analysis of non-enzymatic glycosylation in vivo: Impact of different dialysis solutions. Perit Dial Int 1999;19(suppl 2):S68–S74.
37.
Gotloib L, Shostak A, Wajsbrot V: Effects of osmotic agents upon the in vivo exposed mesothelial monolayer. Perit Dial Int 2000;20(suppl):S11–S14.
38.
Di- Paolo N, Sacchi G, DeMia M, Gaggiotti E, Capotondo L, Rossi P, Bernini M, Pucci AM, Ibba L, Sabatelli P, Alessandrini C: Morphology of the peritoneal membrane during continuous ambulatory peritoneal dialysis. Nephron 1986;44:204–211.
39.
Wilkie ME, Brown CB: Polyglucose solutions in CAPD. Perit Dial Int 1997;17(suppl 2):S47–S50.
40.
Shostak A, Gotloib L: Increased peritoneal permeability to albumin in streptozotocin diabetic rats. Kidney Int 1996;49:705–714.
41.
Rubin J, McFarland S, Hellems EW, Bower JD: Peritoneal dialysis during peritonitis. Kidney Int 1981;19:460–464.
42.
Krediet RT, Zuyderhoudt FM, Boeschoten EW, Arisz L: Alterations in the peritoneal transport of water and solutes during peritonitis in continuous ambulatory peritoneal dialysis patients. Eur J Clin Invest 1987;17:43–52.
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