A comparison between the effects of icodextrin and glucose 2.27% on plasma volume in peritoneal dialysis patients

Peritoneal dialysis (PD) patients are mostly overhydrated. Overhydration could
induce hypertension and increase the cardiac workload. In PD, ultrafiltration
of bodywater occurs by dialysis fluids containing different concentrations of
glucose. More ultrafiltration could be realised by using icodextrin, a dialysis
fluid which contains polymers of glucose. Although use of icodextrin or glucose
fluids is not different for blood pressure as expected, because of the better
ultrafiltration capacity of icodextrin. In this study we will compare the
effect of icodextrin in peritoneal dialysis with glucose-containing dialysis
fluids. Especially regulation of the blood pressure and the distribution of
the body water will be studied.

The primary hypothesis of the study is that the use of icodextrin leads to a
reduction in extracellular volume compared to glucose 2.27%, but that the
effects of icodextrin and glucose 2.27% on plasma will not differ.

Patients will be studied according to a randomized cross-over design. The total
duration of the study is 3 months. During a period of one month all patients
are prescribed 2.27% glucose solutions for the long dwell. After the run-in
period patients will receive one-monthly treatment with icodextrin for the log
dwell followed by one-monthly treatment with glucose 2.27% for the long dwell
(A-B), or will start with glucose 2.27% and followed by icodextrin (B-A).

Blood sampling
24-hours blood pressure monitoring
I-125 albumine method for assessment of plasma volume
Bromide dilution method for assessment of the extracellular volume
Multifrequency bioimpedance analysis for assessment of the total body water
Assessment of peritoneal ultrafiltration volume and sodium removal by 24-hours
dialysate collection
Assessment of residual renal function by 24-hours urine collection

There are no other risks for the patients than known in peritoneal dialysis.