Possible applications of polyglucose (icodextrin) as a peritoneal dialysis fluid

Hyperosmolar glucose is the most frequently used peritoneal dialysis (PD) solution, reaching the maximum of ultrafiltration capacity after 4-6 hrs dwell time. Due to a high peritoneal transport rate of small solutes, there is considerable glucose absorption into the circulation, leading to loss of the osmotic driving force and subsequent loss of UF capacity, resulting in impaired ultrafiltration and fluid retention on one hand and hyperglycemia, hyperlipidemia, and overweight on the other. The glucose polymer icodextrin, a mixture of high molecular weight oligosaccharides of variable chain length ranging from 4-30 glucose units, represents an alternative option. The 7.5% solution is iso-osmolar with uremic serum and only small amounts are absorbed into the circulation. Ultrafiltration achieved by icodextrin, particularly during long dwell exchanges, is more efficient than that achieved by glucose. The use of icodextrin reduces suppression of phagocyte function as well as formation of advanced glycation end products (AGEs) induced by heat sterilization. As a consequence, there are several treatment options and advantages of icodextrin: (a) in chronic UF failure, occuring after a prolonged period of time on peritoneal dialysis, icodextrin will extend PD technique survival, (b) in high transporters long dwell exchanges can be used, e.g. in CAPD (continuous ambulatory PD) or during day time in CCPD (continuous cyclic PD), (c) in acute peritonitis UF is maintained, and (d) in diabetes mellitus nocturnal glucose load is considerably reduced. In conclusion, use of icodextrin plays a significant role in optimizing treatment of PD patients.