대한신장학회

논문분류	춘계학술대회 초록집
제목	Effect of Icodextrin Solution on Preservation of Residual Renal Function in Peritoneal Dialysis Patients
저자	Tae Ik Chang, Dong-Ryeol Ryu, Tae-Hyun Yoo, Hyung Jong Kim, Ea Wha Kang, Hyunwook Kim, Jae Hyun Chang, Dong Ki Kim, Sung Jin Moon, Soo Young Yoon, Seung Hyeok Han
출판정보	2015; 2015(1):
키워드	아이코덱스트린 투석액, 잔여신기능, 복막투석
초록	Background: Preservation of residual renal function (RRF) is important to improve clinical outcomes in patients undergoing peritoneal dialysis (PD). Although icodextrin solution has been highlighted in many aspects compared to glucose-based solution, proof of a beneficial effect of icodextrin solution on RRF is lacking. Methods: We conducted a multicenter prospective randomized controlled open-label trial to investigate whether icodextrin solution can preserve RRF. One hundred patients who met inclusion criteria at 8 centers in Korea were randomly assigned to receive one exchange of icodextrin solution for ≥8 hour-dwell and two exchanges of 1.5% glucose-based biocompatible neutral pH solution or one exchange of ≥2.5% and two exchanges of 1.5% glucose- based biocompatible solutions. These patients had daily urine output ≥750 ml at enrolment. The primary outcome was changes in RRF including residual GFR and daily urine output at 1 year. These were analyzed using mixed-effects general linear models. Results: Among eligible patients, 49 were assigned to icodextrin group and 51 to glucose solution group. The mean age was 53.6 years and 57% had diabetes. Overall, there were no differences in baseline characteristics between the two groups. During follow-up, the slope of decline in residual GFR was -0.51 ml/min/month/1.73m2 in icodextrin group, while it was -0.47 ml/min/month/1.73m2 in glucose solution group (95% CI, -0.19 to 0.27; p=0.728). Of note, daily urine output declined faster in glucose solution group than in icodextrin group (-90.01 vs. -38.66 ml/month; 95% CI, -97.34 to -5.36; p=0.029). The results remained the same when we analyzed these using intention-to-treat and per protocol principles. Volume status assessed by echocardiography and bioelectrical impedance analysis, peritoneal ultrafiltration, and peritoneal membrane transport did not differ between the two groups during follow-up. Conclusion: Icodextrin solution attenuated the rate of decline in daily urine output compared to glucose solution, but did not affect residual GFR. Further long-term studies are required to examine whether icodextrin solution may provide a beneficial clinical outcomes via better preservation of urine volume in patients undergoing PD. ClinicalTrials.gov Identifier: NCT01170858
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