Effect of icodextrin-based peritoneal dialysis solution on peritoneal membrane.

Using changes in cell counts and levels of cancer antigen 125 (CA125), fibrinogen degradation product (FDP), and interleukin-6 (IL-6) in effluent before and after the use of icodextrin-based peritoneal dialysis solution (icodextrin), we evaluated the effects of icodextrin on peritoneal membrane. The subjects were 8 anuric patients (4 men, 4 women) who had been using a 2.5% glucose-based dialysis solution (glucose solution) for the overnight dwell. The mean age of the patients was 57.9 +/- 6.1 years, and their mean duration of continuous ambulatory peritoneal dialysis was 61.6 +/- 44.3 months. In all patients, chronic glomerulonephritis was the cause of end-stage renal disease. We changed the 2.5% glucose solution used for the 8-hour dwell to an icodextrin, and we compared cell counts in effluent and levels of IL-6, FDP, and CA125 in the overnight effluent before, and 12 and 36 weeks after, the switch to the icodextrin. When 2.5% glucose solution was used for the overnight 8-hour dwell, the mean cell count in the effluent was 5.5 +/- 3 cells/mm3. However, 12 and 36 weeks after the start of icodextrin, mean cell counts in effluent were significantly increased to 15.3 +/- 7.7 cells/mm3 (p < 0.01) and 16.5 +/- 11.2 cells/mm3 (p < 0.01) respectively. Values of effluent CA125, FDP, and IL-6 obtained during the use of a glucose solution were compared to values obtained 12 and 36 weeks after the start of icodextrin. Effluent levels of CA125 and IL-6 did not vary before and after the use of the icodextrin, but levels of FDP in the icodextrin effluent were higher than the levels found in the effluent of a 2.5% glucose solution (7278.8 +/- 2915 ng/mL before the start of icodextrin; 29,875 +/- 13,227 ng/mL 12 weeks after icodextrin introduction, p < 0.01; and 12,062.9 +/- 5684.6 ng/mL 36 weeks after icodextrin introduction). Icodextrin induced a subclinical inflammatory response in the peritoneum. Therefore, biocompatibility of an icodextrin solution is not always superior to that of a glucose solution, and further research is needed to clarify the influence of long-term icodextrin use on the peritoneum.