A Meta-Analysis of Icodextrin versus Glucose Containing Peritoneal Dialysis in Metabolic Management of Peritoneal Dialysis Patients

OBJECTIVES: The objective of this article is to study the available works on comparison between icodextrin-based solutions (ICO) and glucose-based solutions (GLU) in peritoneal dialysis (PD) patients. The final aim was to get evidence for potential differences in metabolic management of PD patients by comparing the ICO with the GLU for the long dwell once a day. METHODS: A meta-analysis of included reports, identified by MEDLINE and other sources, containing information on fasting plasma glucose, total cholesterol, triglycerides, and so on in PD patients, was performed. RESULTS: Nine randomized controlled trials (RCTs) (553 patients) were included. The ICO did not differ from the GLU with respect to fasting plasma glucose (weighted mean difference (WMD) = -0.76; 95% confidence interval (CI) = -1.79 to 0.28; Z = 1.43; p = 0.15), triglycerides (WMD = -0.66; 95% CI = -1.40 to 0.09; Z = 1.73; p = 0.08), and body weight (WMD = -2.02; 95% CI = -5.06 to 1.03; Z = 1.30; p = 0.20). But peritoneal creatinine clearance (WMD = 0.49; 95% CI = 0.34-0.64; Z = 6.35; p < 0.00001), urea clearance (WMD = 0.40; 95% CI = 0.25-0.55; Z = 5.12; p < 0.00001), and plasma total cholesterol (WMD = -0.40; 95% CI = -0.70 to -0.10; Z = 2.64; p = 0.008) were higher for the ICO versus the GLU. CONCLUSIONS: The ICO had been shown to have significant advantages over the GLU in small solute clearance and plasma total cholesterol. Patients, no matter what kind of PD solution was used, had no significant difference of plasma triglycerides, fasting plasma glucose, and body weight.