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ORIGINAL RESEARCH article

Front. Physiol.
Sec. Renal Physiology and Pathophysiology
Volume 15 - 2024 | doi: 10.3389/fphys.2024.1339762
This article is part of the Research Topic Advances and Insights in Peritoneal Dialysis: A Physiological Perspective View all 9 articles

Can one long peritoneal dwell with icodextrin (Extraneal) replace two short dwells with glucose?

Provisionally accepted
Joanna Stachowska-Pietka Joanna Stachowska-Pietka 1*Jacek Waniewski Jacek Waniewski 1Anna Olszowska Anna Olszowska 2Elvia Garcia Lopez Elvia Garcia Lopez 3Junfei Yan Junfei Yan 4Qiang Yao Qiang Yao 4Zofia Wańkowicz Zofia Wańkowicz 2Bengt Lindholm Bengt Lindholm 3
  • 1 Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
  • 2 Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
  • 3 Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet (KI), Huddinge, Stockholm, Sweden
  • 4 Baxter (China), Shanghai, China

The final, formatted version of the article will be published soon.

    Background: Due to slower dissipation of the osmotic gradient, icodextrin-based compared to glucose-based solutions can improve water removal. We investigated scenarios where one icodextrinbased long dwell (Extraneal) replaced two glucose-based exchanges.The three-pore model with icodextrin hydrolysis was used for numerical simulations of single exchange to investigate the impact of different peritoneal dialysis schedules on fluid and solute removal in patients with different peritoneal solute transfer rate (PSTR). We evaluated water removal (ultrafiltration, UF), absorbed mass of glucose (AbsGluc) and carbohydrates (AbsCHO, for glucose and glucose polymers), ultrafiltration efficiency (UFE=UF/ AbsCHO) per single exchange and specified dwell time, and removed solute mass for sodium (ReNa), urea (ReU), and creatinine (ReCr) for single peritoneal exchange with Extraneal 7.5% icodextrin (Extraneal®) and glucose-based solutions (1.36% and 2.27%) and various dwell durations in patients with fast and average PSTR.Results: Introducing 7.5% icodextrinExtraneal for the long dwell to replace 1 of 3 or 4 glucose-based exchanges per day leads to increased fluid and solute removal and higher UF efficiency for studied transport groups. Replacing two glucose-based exchanges with one icodextrinExtraneal exchange provides higher or similar water removal and higher sodium daily removal but slightly lower daily removal of urea and creatinine, irrespectively of the transport type present in case of reference prescription with 3 and 4 daily exchanges.Conclusions: One 7.5% icodextrinExtraneal can replace two glucose solutions. Unlike glucose-based solutions, it resulted only in minor differences between PSTR groups in terms of water and solute removal with UFE remaining stable up to 16 hours.

    Keywords: Chronic Kidney Disease, Peritoneal Dialysis, Icodextrin, Ultrafiltration, Sodium removal, glucose absorption, ultrafiltration efficiency

    Received: 16 Nov 2023; Accepted: 16 May 2024.

    Copyright: © 2024 Stachowska-Pietka, Waniewski, Olszowska, Garcia Lopez, Yan, Yao, Wańkowicz and Lindholm. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Joanna Stachowska-Pietka, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.