Hiramatsu T, Furuta S, Kakuta H
Long-Term Effects of Icodextrin on Cardiovascular Parameters in
Peritoneal Dialysis Patients with Volume Overload.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol
(Nov) 18:707A 2007

Background and aim: Volemic status and cardiac hypertrophy are risk
factors for mortality in peritoneal dialysis (PD) patients. Icodextrin has
been used to improve ultrafiltration (UF) without further dextrose load in PD
patients. However, little is known for its long-term effects on
cardiovascular parameters such as left ventricular mass index (LVMI) in PD
patients with volume overload. The aim of this study was, therefore, to
elucidate the effects of icodextrin evaluated by ultrasonographic
cardiovascular indices and natriuretic peptides for 2 years in such
patients.
Methods: PD patients with congestion were selected
for this retrospective analysis. Cardiovascular ultrasonographic (USG)
indices and natriuretic peptides were measured every 6 months. Data available
from a total of 18 patients for 1 year before and 2 years after the start of
icodextrin use were analyzed.
Results: 1) The average age was
55.9 years. 2) The average PD duration was 33.5 months. 3) Cardiac
hypertrophy assessed by LVMI and IVS+PWT (interventricular septum+posterior
LV thickness) decreased significantly after icodextrin use for 2 years. 3)
The values for IMT and IMA at the start had deteriorated in comparison with
those at 1 year before the start of icodextrin. 4) None of E/A (ratio of peak
early diastolic filling velocity to peak filling velocity at atrial
contract), RWT (relative cardiac wall thickness), IMT (intima-media thickness
of cervical artery) or IMA (intima-media area of cervical artery) showed any
statistically significant changes after icodextrin use. 5) Atrial natriuretic
peptide (ANP) was lower after icodextrin use for 1 and 2 years. 5) Brain
natriuretic peptide (BNP) was lower for 2 years although it
s statistical difference was achieved only for the
first year. 6) There were statistically significant increases in both daily
UF volume and daily total water removal, whereas significant decreases in
daily urinary volume over time.
Conclusion: Cardiac hypertrophy
evaluated by USG and natriuretic peptides were improved in congestive PD
patients after icodextrin use, with consistently increased total water
removal over time.
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