Silver Samuel A, Harel Ziv, Perl Jeffrey
Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ont., Canada.
Am J Nephrol. 2014;39(6):515-27. doi: 10.1159/000363417. Epub 2014 Jun 11.
Icodextrin is a peritoneal dialysis solution that is commonly used to increase ultrafiltration during the long dwell. The other major clinical benefit of icodextrin is that it is glucose-sparing, which may help preserve peritoneal membrane function. Since it has a different chemical composition than dextrose, and with its increasing use, there are several clinical considerations healthcare providers must familiarize themselves with prior to prescribing icodextrin.
Failure to recognize these special properties of icodextrin can lead to adverse events reaching patients. This narrative review explores the hemodynamic, metabolic, and idiopathic effects of icodextrin to facilitate the safe use of icodextrin in peritoneal dialysis.
Hemodynamic effects include hypotension from enhanced ultrafiltration contributing to loss of residual kidney function. Metabolic effects include the chemical structure of icodextrin interfering with biochemical assays, resulting in misleading glucose readings on non-specific glucometers. Idiopathic adverse effects include a diffuse rash and sterile peritonitis. It is also important to remember that not all antibiotic combinations have undergone stability testing in icodextrin. This narrative review will help healthcare providers to confidently prescribe icodextrin to maximize its benefit in peritoneal dialysis patients.
艾考糊精是一种腹膜透析液，常用于在长时间留腹期间增加超滤量。艾考糊精的另一个主要临床益处是它可以节省葡萄糖，这可能有助于保护腹膜功能。由于其化学成分与葡萄糖不同，且使用越来越广泛，医疗服务提供者在开具艾考糊精处方之前必须熟悉一些临床注意事项。
未能认识到艾考糊精的这些特殊性质可能会导致患者出现不良事件。这篇叙述性综述探讨了艾考糊精的血流动力学、代谢和特发性效应，以促进其在腹膜透析中的安全使用。
血流动力学效应包括因超滤增强导致的低血压，这会导致残余肾功能丧失。代谢效应包括艾考糊精的化学结构干扰生化检测，导致在非特异性血糖仪上出现误导性的血糖读数。特发性不良反应包括弥漫性皮疹和无菌性腹膜炎。同样重要的是要记住，并非所有抗生素组合都在艾考糊精中进行过稳定性测试。这篇叙述性综述将帮助医疗服务提供者自信地开具艾考糊精处方，以使其在腹膜透析患者中的益处最大化。
