Lin Wei, Chen Yung-Chih, Wu Mai-Szu, Hsu Heng-Jung, Sun Chiao-Yin, Lin Ying-Kuang, Wu I-Wen
Division of Nephrology, Kuo General Hospital, Tainan, Taiwan.
Ren Fail. 2009;31(2):98-105. doi: 10.1080/08860220802595500.
Previous studies demonstrate that icodextrin is superior to 4.25% dextrose for fluid removal in patients with high and high-average transport membrane. Recent studies reveal that controlling volume status improves malnutrition in peritoneal dialysis (PD) patients. This study hypothesized that icodextrin enhances nutritional and inflammatory status by improving fluid balance.
This retrospective case-control study investigated the effects of icodextrin on patient nutritional profiles over a one-year period. Thirty-two patients who used icodextrin for more than one year were classified as the "icodextrin group." Ten patients who used glucose-containing dialysate without icodextrin were classified as the control group. Clinical and laboratory parameters were compared between groups. Demographic and laboratory parameters were analyzed at baseline, 3 months, 6 months, and 12 months after starting icodextrin dialysis.
Ultrafiltration of icodextrin per exchange in the icodextrin group was 66% higher than that for 4.25% dextrose exchange in the icodextrin group (icodextrin vs. 4.25% dextrose: 492.1 +/- 204.5 vs. 296.1 +/- 115.3 mL/exchange; p < 0.0001, paired t-test). The increased albumin and normalized protein catabolic rate (nPCR) after icodextrin for one year was unique for the icodextrin group (p < 0.0001 and p < 0.0001, respectively). The inflammatory marker high sensitivity C-reactive protein (hsCRP) decreased significantly only in the icodextrin group (p = 0.0048).
Icodextrin dialysate may improve nutritional and inflammatory status in PD patients. However, the long-term clinical effects of icodextrin require further study.
既往研究表明，对于高转运和高平均转运膜的患者，艾考糊精在清除液体方面优于4.25%葡萄糖。近期研究显示，控制容量状态可改善腹膜透析（PD）患者的营养不良状况。本研究假设艾考糊精可通过改善液体平衡来增强营养和炎症状态。
这项回顾性病例对照研究调查了艾考糊精在一年时间内对患者营养状况的影响。32名使用艾考糊精超过一年的患者被归类为“艾考糊精组”。10名使用不含艾考糊精的含糖透析液的患者被归类为对照组。比较两组的临床和实验室参数。在开始艾考糊精透析后的基线、3个月、6个月和12个月分析人口统计学和实验室参数。
艾考糊精组每次交换的超滤量比该组4.25%葡萄糖交换的超滤量高66%（艾考糊精组与4.25%葡萄糖组比较：492.1±204.5 vs. 296.1±115.3 mL/次交换；p<0.0001，配对t检验）。艾考糊精治疗一年后白蛋白增加和蛋白分解代谢率正常化（nPCR）是艾考糊精组独有的情况（分别为p<0.0001和p<0.0001）。炎症标志物高敏C反应蛋白（hsCRP）仅在艾考糊精组显著降低（p = 0.0048）。
艾考糊精透析液可能改善PD患者的营养和炎症状态。然而，艾考糊精的长期临床效果需要进一步研究。
