Sav Tansu, Oymak Oktay, Inanc Mehmet Tugrul, Dogan Ali, Tokgoz Bulent, Utas Cengiz
Department of Nephrology, Government Hospital, Erciyes University, Kayseri, Turkey.
Perit Dial Int. 2009 Jul-Aug;29(4):443-9.
Hypervolemia is a risk factor for left ventricular hypertrophy and hypertension in peritoneal dialysis patients. Icodextrin improves volume control by increasing ultrafiltration in peritoneal dialysis patients.
To examine the effects of twice-daily icodextrin administration on blood pressure and left ventricular hypertrophy in peritoneal dialysis patients with hypervolemia and ultrafiltration failure.
Administration of icodextrin twice daily resulted in a significant reduction in the left ventricular mass index (LVMI) of patients by the end of the third month (p < 0.05). The reduction in LVMI was also significant for the once-daily icodextrin group (p < 0.05). Mean blood pressure of patients receiving icodextrin twice daily was significantly reduced (p < 0.05). By the end of the third month no significant changes were observed in mean blood pressure of the patients using once-daily icodextrin (p > 0.05). No statistically significant changes were observed in weekly total creatinine clearances or Kt/V of patients in either group at the end of 3 months (NS).
Twice-daily icodextrin administration was clinically beneficial as shown by reduced blood pressure and prevention of the progress of left ventricular hypertrophy without causing any decrease in dialysis adequacy or any side effects. The icodextrin metabolite results did not suggest any further increase in their values when comparing once- to twice-daily administration of icodextrin. Although prescription of icodextrin once daily may yield good clinical results in the long term, this study showed that it may be more efficient to use twice-daily icodextrin for at least a specific period for the purpose of obtaining quicker results in patients with ultrafiltration failure, serious hypervolemia, or hard-to-control blood pressure conditions.
容量过多是腹膜透析患者左心室肥厚和高血压的危险因素。艾考糊精可通过增加腹膜透析患者的超滤来改善容量控制。
研究每日两次给予艾考糊精对容量过多且超滤失败的腹膜透析患者血压及左心室肥厚的影响。
每日两次给予艾考糊精，到第三个月末患者的左心室质量指数（LVMI）显著降低（p<0.05）。每日一次给予艾考糊精的组中LVMI降低也很显著（p<0.05）。每日两次接受艾考糊精治疗的患者平均血压显著降低（p<0.05）。到第三个月末，每日一次使用艾考糊精的患者平均血压未观察到显著变化（p>0.05）。3个月末两组患者的每周总肌酐清除率或Kt/V均未观察到有统计学意义的变化（无显著性差异）。
每日两次给予艾考糊精具有临床益处，表现为血压降低以及预防左心室肥厚进展，且未导致透析充分性下降或出现任何副作用。比较艾考糊精每日一次与每日两次给药时，艾考糊精代谢产物结果未提示其值有进一步升高。虽然长期每日一次开具艾考糊精处方可能会产生良好的临床效果，但本研究表明，对于超滤失败、严重容量过多或血压难以控制的患者，为了更快获得疗效，至少在特定时期每日两次使用艾考糊精可能更有效。
