Exploring new evidence of the clinical benefits of icodextrin solutions

Background. Use of icodextrin has the potential of several clinical benefits, including reduced systemic and peritoneal glucose exposure and improvement in fluid status as a result of better ultrafiltration. This article explores the recent evidence for such benefits. Methods. Systematic literature review to include all randomized controlled trials and longitudinal observational cohort studies of peritoneal dialysis patients treated with icodextrin. Secondary, comparative analysis of the relationship between increased ultrafiltration and preservation of residual urine volume. Results. Several studies provide support for clinically relevant improvements in biocompatibility. In particular, improved glucose control in diabetics and hyperinsulinaemia and gastric emptying in non-diabetics indicate systemic benefits. Evidence for improved lipid profiles of blood pressure control is less compelling. The increases in net ultrafiltration, especially in high transport patients, in whom glucose solutions are associated with fluid reabsorption in the long dwell, are associated with sustained reductions in the extra-cellular fluid volume. For a given increase in ultrafiltration, residual urine volume is relatively well-preserved with icodextrin, but severe volume depletion puts residual renal function at risk. Considerable variability in achieved ultrafiltration is observed. Conclusion. The potential clinical benefits of icodextrin are increasingly supported by observational and randomized studies. Further research is required in order to understand the between-patient variability in the efficacy of ultrafiltration achieved with icodextrin, which might in part be explained by differences in metabolism.