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NDT Advance Access originally published online on December 7, 2005
Nephrology Dialysis Transplantation 2006 21(3):820; doi:10.1093/ndt/gfi261
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Letters and Replies

Icodextrin and haemodynamics

H. Feidhlim Woods

Fresenius Medical Care Asia Pacific Medical Department 5101 Sun Hun Gai Centre 30 Harbour Road Hong Kong

Email: Feidhlim.Woods{at}fmc-asia.com

Sir,

In their study comparing the acute haemodynamic changes associated with a single peritoneal dialysis exchange of 1.36 and 3.86% dextrose and icodextrin peritoneal dialysate, Selby et al. [1] are surely missing the most likely reason for the differences they describe.

The 3.86% dextrose exchange was associated with better maintenance of cardiac output for equivalent change in total peripheral resistance. In turn, this must translate to higher mean arterial pressure. The most likely explanation is the greater ultrafiltration achieved with 3.86% dextrose compared with the other dialysates. The elderly patients they studied with the co-morbidities described make it highly likely that these patients would suffer from incipient cardiac failure. In that setting, the cardiac ejection fraction improves in response to ultrafiltration.

What Selby et al. describe is not an adverse haemodynamic response to hypertonic dextrose but rather evidence of an appropriate inotropic response to reduced cardiac pre-load. The authors provide no evidence for a superior haemodynamic response comparing icodextrin and hypertonic dextrose.

Conflict of interest statement. Dr H. Feidhlim Woods is an employee of Fresenius Medical Care.



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  1. Selby NM, Fonsexa S, Hulme L, Fluck RJ, Taal MW, McIntyre CW. Hypertonic glucose-based peritoneal dialysate is associated with higher blood pressure and adverse haemodynamics as compared with icodextrin. Nephrol Dial Transplant 2005; 20: 1848–1853[Abstract/Free Full Text]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
21/3/820    most recent
gfi261v2
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