Icodextrin metabolites in peritoneal dialysis

Abstract

In summary, glucose exhibits many characteristics that have served it well for several decades as the primary osmotic agent for long-term PD, but the more recent introduction of icodextrin and another glucose-sparing osmotic agent has enabled the development of prescriptions that reduce the metabolic side effects of glucose in both diabetic and nondiabetic patients (50,51). Equally important, icodextrin has been shown to improve peritoneal UF and therefore water balance (52). Icodextrin is absorbed to the vascular compartment and is there rapidly metabolized by amylase so that plasma contains mainly small oligosaccharides (especially maltose, maltotriose, and maltotetraose). Intraperitoneal amylase-dependent metabolism of icodextrin also occurs, resulting in the formation of these and larger metabolites. The metabolism of absorbed icodextrin and the resultant rise in plasma levels of its metabolites do not seem to contribute to hyperglycemia or hyperinsulinemia. Furthermore, after nearly 20 years of using icodextrin for the long dwell in peritoneal dialysis patients, apart from rash, no clinical complications due to the presence of icodextrin metabolites in the circulation have been demonstrated. Copyright © 2009 International Society for Peritoneal Dialysis.