Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Clin J Am Soc Nephrol. 2011 Jun;6(6):1337-44. doi: 10.2215/CJN.10041110. Epub 2011 Apr 14.
There are still controversies whether peritoneal dialysis (PD) with icodextrin preserves residual renal and peritoneal membrane functions in patients with diabetes. However, there are no randomized controlled and long-term clinical trials in newly started PD patients with diabetic nephropathy.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Forty-one patients with diabetic nephropathy with ESRD were enrolled and randomly assigned to the glucose group (GLU) treated with 8 L of 1.5% or 2.5% glucose or an icodextrin group (ICO) treated with 1.5 or 2.0 L of 7.5% icodextrin-containing solutions. Technique failure, body fluid management, glucose and lipid metabolism, and residual renal and peritoneal functions and were evaluated over 2 years.
The technique survival rate was 71.4% in ICO and 45.0% in GLU, with most of the technique failure due to volume overload. ICO showed significantly better cumulative technique survival. Net ultrafiltration volume was significantly higher in ICO throughout the study period. There were no beneficial effects of icodextrin on hemoglobin A1c, glycoalbumin, and lipid profile at 24 months. Urine volume and residual renal function declined faster in ICO, but there were no significant differences between the two groups. For peritoneal function, no differences were observed in dialysis-to-plasma creatinine ratios during the observation.
In PD therapy for diabetic nephropathy, the use of icodextrin-containing solutions has a beneficial effect on technique survival, but there are no apparent benefits or disadvantages in residual renal and peritoneal functions compared with conventional PD with glucose solution.
关于使用艾考糊精的腹膜透析（PD）是否能保留糖尿病患者的残余肾功能和腹膜功能仍存在争议。然而，对于新开始 PD 的糖尿病肾病患者，目前还没有随机对照和长期临床试验。
设计、地点、参与者和测量：共纳入 41 例终末期肾病伴糖尿病肾病患者，随机分为葡萄糖组（GLU），给予 8 L 1.5%或 2.5%葡萄糖；艾考糊精组（ICO），给予 1.5 或 2.0 L 7.5%艾考糊精溶液。评估 2 年内技术失败、体液管理、糖脂代谢以及残余肾功能和腹膜功能。
ICO 组技术生存率为 71.4%，GLU 组为 45.0%，技术失败的主要原因是容量超负荷。ICO 显示出明显更好的累积技术生存率。整个研究期间，ICO 的净超滤量显著更高。在 24 个月时，艾考糊精对糖化血红蛋白、糖基化白蛋白和血脂谱没有有益影响。ICO 组的尿量和残余肾功能下降更快，但两组间无显著差异。对于腹膜功能，观察期间透析液与血浆肌酐比值无差异。
在 PD 治疗糖尿病肾病中，使用含艾考糊精的溶液对技术生存率有有益影响，但与葡萄糖溶液相比，残余肾功能和腹膜功能无明显优势或劣势。
