Konings Constantijn J A M, Kooman Jeroen P, Schonck Marc, Gladziwa Ulrich, Wirtz Joris, van den Wall Bake A Warmold, Gerlag Paul G, Hoorntje Steven J, Wolters Johannes, van der Sande Frank M, Leunissen Karel M L
Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
Kidney Int. 2003 Apr;63(4):1556-63. doi: 10.1046/j.1523-1755.2003.00887.x.
Overhydration is a risk factor for hypertension and left ventricular hypertrophy in peritoneal dialysis patients. Recently, a high prevalence of subclinical overhydration was observed in peritoneal dialysis patients. Aim of the present open-label randomized study was to assess the effect of a icodextrin 7.5% solution on fluid status [extracellular water (ECW) bromide dilution], blood pressure regulation (24-hour ambulatory measurements) and echocardiographic parameters during a study period of 4 months, and to relate the effect to peritoneal membrane characteristics (dialysate/plasma creatinine ratio). Forty peritoneal dialysis patients (22 treated with icodextrin, 18 controls) were randomized to either treatment with icodextrin during the long dwell or standard glucose solutions. Thirty-two patients (19 treated with icodextrin, 13 controls] completed the study. The use of icodextrin resulted in a significant increase in daily ultrafiltration volume (744 +/- 767 mL vs. 1670 +/- 1038 mL; P = 0.012) and a decrease in ECW (17.5 +/- 5.2 L vs. 15.8 +/- 3.8 L; P = 0.035). Also the change in ECW between controls and patients treated with icodextrin was significant (-1.7 +/- 3.3 L vs. +0.9 +/- 2.2 L; P = 0.013). The effect of icodextrin on ECW was not related to peritoneal membrane characteristics, but significantly related to the fluid state of the patients (ECW:height) (r = -0.72; P < 0.0001). Left ventricular mass (LVM) decreased significantly in the icodextrin-treated group (241 +/- 53 grams vs. 228 +/- 42 grams; P = 0.03), but not in the control group. In this randomized open-label study, the use of icodextrin resulted in a significant reduction in ECW and LVM. The effect of icodextrin on ECW was not related to peritoneal membrane characteristics, but was related to the initial fluid state of the patient.
水过多是腹膜透析患者发生高血压和左心室肥厚的一个危险因素。最近，在腹膜透析患者中观察到亚临床水过多的高发生率。本开放标签随机研究的目的是评估4个月研究期间7.5%艾考糊精溶液对液体状态[细胞外液（ECW）溴稀释法]、血压调节（24小时动态测量）和超声心动图参数的影响，并将该影响与腹膜特性（透析液/血浆肌酐比值）相关联。40例腹膜透析患者（22例接受艾考糊精治疗，18例为对照组）被随机分为长期留腹时接受艾考糊精治疗或标准葡萄糖溶液治疗。32例患者（19例接受艾考糊精治疗，13例为对照组）完成了研究。使用艾考糊精导致每日超滤量显著增加（744±767ml对1670±1038ml；P=0.012），且ECW减少（17.5±5.2L对15.8±3.8L；P=0.035）。对照组和接受艾考糊精治疗患者之间的ECW变化也有显著差异（-1.7±3.3L对+0.9±2.2L；P=0.013）。艾考糊精对ECW的影响与腹膜特性无关，但与患者的液体状态（ECW:身高）显著相关（r=-0.72；P<0.0001）。艾考糊精治疗组左心室质量（LVM）显著降低（241±53克对228±42克；P=0.03），而对照组未降低。在这项随机开放标签研究中，使用艾考糊精导致ECW和LVM显著降低。艾考糊精对ECW的影响与腹膜特性无关，但与患者的初始液体状态有关。
