#2637 Comparison of single versus double icodextrin exchanges in patients on CAPD: a study from Chennai, South India
Authors: Manjari Veena , Parthasarathy Rajeevalochana , Nair Sanjeev , Hurmath Syeda , T Suwetha 
Published: May 2024

Abstract

Background and Aims
Dextrose has been used as the primary osmotic agent in PD. Icodextrin is an alternative osmotic agent & is now routinely used as a part of incremental prescription. As per guidelines, only one icodextrin exchange per day is recommended. There is no Indian data on icodextrin only exchanges in PD patients.
In this study we compare single versus double icodextrin exchange per day with regards to ultrafiltration, laboratory parameters and quality of life.

Method
This was a retrospective study was done at The Madras Medical Mission, Chennai, India amongst patients initiated on PD between January 2019 to January 2023. Records of these patients were analysed from initiation of dialysis to one year after start of PD.
Patients were divided into 2 groups.
Group A: Patients on 1 icodextrin exchange per day
Group B: Patients on 2 icodextrin exchanges per day
Inclusion criteria
Patients above 18 yrs
Minimum 3 months of CAPD
Exclusion criteria
Hybrid therapy
Dextrose exchanges
Clinical and laboratory Evaluation
Periodic clinical and lab assessments made at baseline, 3 months, 6 months and 1 year as per our unit protocol were noted. Left ventricular ejection fraction as per ECHO was noted.
Mean ultrafiltration and residual urine output was noted.
Infectious and non-infectious complications from 3 months to 1 year of therapy was analysed. QOL assessed using Kidney Disease Quality of Life (KDQoL™-36) questionnaire.
Statistical analysis was done using SPSS v23 (IBM Corp.).

Results
19 patients were initiated on icodextrin only exchanges. 9 patients were on one icodextrin exchange per day and 10 patients were on two icodextrin exchanges per day. PD prescription in these patients were based on the clinical assessment, laboratory parameters, socioeconomic status.
Baseline characteristics of these patients are shown in Table 1.
UF response
In group A, the mean ultrafiltration decreased from 583 ml at baseline to 541.67 ml at 6 months and 500 ml at 1 year. In group B, the mean ultrafiltration increased from 745 ml at baseline to 994.44 ml at 6 months and 1025 ml at 1 year. Statistically significant difference in between the two groups were noted at 3 (p = 0.04) & 6 months (p = 0.003). No significant difference was noted at one year (p = 0.167).
Blood pressure
The two groups did not differ in terms of systolic and diastolic pressure.
Residual urine output (RUO)
The mean RUO in group A at baseline, 6 months and 1 year were 822.22 ml, 816.67 ml and 933.33 ml respectively. The mean RUO in group B at baseline, 6 months and 1 year were 965 ml, 613.33 ml and 700 ml respectively. The overall change in RUO over time was compared in the 2 groups using the Generalized Estimating Equations method. There was a significant difference in the trend of RUO over time between the two groups (p &lt; 0.001).
Random blood sugar, serum sodium, LVEF
No significant difference was noted between the two groups. Table 2 shows the mean values at different time points.
Pulmonary oedema
No difference was noted between the groups. Patients were managed with additional exchanges of 4.25% dextrose for 2 to 3 days. No change in the prescription after resolution of pulmonary oedema.
Adverse reactions
1 patient on two icodextrin exchanges developed hyponatremia & was switched to dextrose exchanges. No skin reaction due to icodextrin was noted.
Quality of life
In group A mean QOL at baseline, 6 months and 12 months were 191, 301.33 and 243 respectively. In group B, the mean QOL at baseline, 6 months and 12 months were 194.67, 306.5, and 248 respectively. There was no significant difference in the trend of QOL between the two groups (p = 0.997).
Outcome
One patient died due to septic shock
Cost (in Indian rupees)
Mean cost of PD per month in these patients were Rs 23760 in group A and Rs 42768 in group B. There was a significant difference between the 2 groups in terms of cost (p = 0.001), with the median cost being highest in the group B.

Conclusion
A significant increase in ultrafiltration was noted in patients on two exchanges of icodextrin. However, patients on two exchanges had a significant decrease in residual urine output.