Journal Watch
Don’t trust glucometers on people using PD with icodextrin
Glucometer test strips can’t distinguish glucose from other sugars, like maltose. When icodextrin is used for PD in people with diabetes, standard glucometer use is risky. Blood glucose test results from glucometers can’t be trusted, and people may be given insulin they don’t need (which could cause coma or death). Three case reports show why this is the case—and the authors suggest using glucose-specific blood tests instead.
Read the abstract » | (added 2014-12-09)
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All about icodextrin – in one place
A new review explains why and how to use icodextrin appropriately and avoid adverse events. Learn about the hemodynamic, metabolic, and idiopathic effects of this glucose-sparing PD fluid so you can prescribe it with confidence.
Read the abstract » | (added 2014-07-07)
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Japanese strategy to prevent encapsulating peritoneal sclerosis (EPS)
EPS is a rare and severe complication of PD. Japanese clinicians offer a multidisciplinary approach to avoid EPS and improve outcomes for those who have it. Icodextrin and combination PD/HD treatment is used, and high-risk patients have planned PD stoppage. Between 2008 and 2012, the incidence of EPS was 0.3% for PD < 3 years, 0.6% for PD = 5 years, 2.3% for PD = 8 years, and 1.2% for PD > 8 years. Prednisone (n=11) and surgery (n=2) were used to treat EPS; remission occurred in 12 of the patients (85.7%), while 3 died (21.4%).
Read the abstract » | (added 2014-03-07)
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PD fluid: Does less sugar lead to better outcomes?
A recent randomized, controlled trial with 251 patients combined two studies of standard vs. low-glucose PD fluids. The study looked at hemoglobin A1c levels. In the low-glucose fluid group, A1c and triglyceride levels dropped and lipid profiles improved. But...there were more serious events and deaths in this group due to fluid overload. So, the low-glucose fluid was better for blood sugar and lipids, but with a higher risk of fluid problems. The authors suggest that if low-glucose fluids (like icodextrin) are used, it is vital to watch fluid levels closely.
Read the abstract » | (added 2013-12-10)
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Icodextrin metaanalysis – no impact on patient survival
Australian researchers analyzed 11 studies of icodextrin vs. glucose PD fluid (1222 patients). Icodextrin did help reduce fluid overload without harming residual kidney function. But, it did not help reduce peritonitis, technique failure, or other adverse events. And, patients who used icodextrin did not live any longer.
Read the abstract » | (added 2013-04-29)
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Alert: Icodextrin PD fluid can mask hypoglycemia
A case report of an 80 year old man in the emergency room highlights the need for healthcare providers to be aware of the impact of icodextrin PD fluid on blood sugar. Handheld glucose meters can overestimate blood sugar. A lab test can verify blood sugar if symptoms of hypoglycema are present and the glucometer reading is normal.
Read the abstract » | (added 2013-02-27)
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Yes, PD can be done with diabetes
PD is gentle on the blood vessels. With use of icodextrin and other steps to optimize glucose and volume control, it can be a good option for those with diabetes.
Read the abstract » | (added 2011-11-28)
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Blood glucose meters may overestimate blood sugar levels when Icodextrin PD fluid is used
If you use a blood sugar monitor, you need to be able to trust the results. But, they may not be accurate if you use Icodextrin PD fluid. A case report of four people with insulin-dependent diabetes found that their blood sugar monitor readings were normal—at the same time that their hospital drawn blood sugars were dangerously low.
Read the abstract » | (added 2011-07-26)
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Better PD technique survival in people with diabetes who use icodextrin
In the first randomized control trial using icodextrin in lieu of glucose for PD solution, 41 people with diabetic nephropathy were assigned one or the other. After 2 years, 71.4% of the icodextrin group was still doing PD, while only 45% who used glucose-based solution still did PD.
Read the abstract » | (added 2011-04-25)
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Better fluid removal with icodextrin PD fluid - Meta-analysis
A new study of 9 randomized controlled trials has found that people using icodextrin removed much more water than those using glucose based fluid—with no change in residual kidney function or increase in peritonitis or death. Rash was more common in those using icodextrin.
Read the abstract » | (added 2011-03-30)
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