Nephrol Dial Transplant (2000) 15: 862-866
© 2000 European Renal Association-European Dialysis and Transplant Association
Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis
Renal Unit, Leeds General Infirmary and 1 Centre for Bone and Body Composition Research, University of Leeds, Leeds, UK
Background. Glucose absorption from glucose-based dialysis fluids limits ultrafiltration from the daytime dwell in automated peritoneal dialysis (APD). Icodextrin may allow greater ultrafiltration during the daytime period in APD, enhancing fluid control.
Methods. A 7.5% icodextrin dialysate was compared with a 2.27% glucose dialysate for the daytime dwell in 14 subjects on APD. Blood pressure, weight and body water compartments estimated by multifrequency bioelectrical impedance (MFBIA) were determined in subjects using 2.27% glucose as the daytime dwell and then repeated 1 month after switching to icodextrin.
Results. Icodextrin resulted in symptomatic hypotension requiring reduction of antihypertensive medication in six of the 14 patients. Despite this reduction in treatment, systolic blood pressure fell from 142.4 (23.9) mmHg to 122.9 (17.7) mmHg, P<0.005, and diastolic blood pressure tended to fall from 82.8 (9.8) mmHg to 76.8 (10.1) mmHg, P=0.075. Change in systolic blood pressure significantly correlated with changes in weight (r=0.62, P<0.05) and MFBIA estimates of total body water (TBW) (r=0.56, P<0.05), extracellular water (ECW) (r=0.79, P<0.002), extra/intracellular water ratio (ECW/ICW) (r=0.72, P<0.01) and derived resistances Recf of ECW (r=-0.69, P<0.01) and Rinf of TBW (r=-0.66, P<0.02). Changes in diastolic blood pressure significantly correlated with changes in ECW (r=0.64, P<0.02) and ECW/ICW ratio (r=0.58, P<0.05), and almost significantly with Recf (r=-0.51, P=0.08) and Rinf (r=-0.52, P=0.07) estimated by MFBIA, but not with changes in weight or TBW.
Conclusions. Use of icodextrin for the daytime dwell in APD results in improved fluid balance and blood pressure control compared with 2.27% glucose. MFBIA detected clinically important changes in fluid content in these patients.
Keywords: automated peritoneal dialysis; bioelectrical impedance; body water; hypertension; icodextrin; ultrafiltration
Correspondence and offprint requests to: Dr Graham Woodrow, Consultant in Renal Medicine, Renal Unit, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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