Icodextrin Is Associated With Lower Risks of Peritonitis, Technique Failure, and Mortality: A Cohort Study From Taiwan

Background: It studied the effects of icodextrin (ICO) on the risks of peritonitis, switching to HD, death and technique failure in a large group of PD patients using extended data from a medical center in Taiwan. Methods: The study included incident PD patients receiving PD for at least 90 days from Jan. 1, 2007 to Dec. 31, 2018 at China Medical University Hospital, Taiwan. ICO users were defined as use of ICO for >50% of their PD duration. ICO was considered a time-varying exposure in Cox proportional hazard model. The outcomes of interest were the first episode of peritonitis, switching to HD (defined as transfer to HD for at least 30 days), death, and technique failure (defined as transfer to HD for at least 30 days or death on PD). If patients died within 90 days after switching to HD, the death was attributed to PD and counted as a death event. Results: A total of 725 PD patients including 190 ICO users and 535 ICO non-users were recruited. Compared to ICO non-users, ICO users had significant lower risks of the first peritonitis episode (adjusted HR=0.22, 95% CI=0.14-0.34), switching to HD (adjusted HR=0.55, 95% CI=0.37-0.80), mortality (adjusted HR=0.58, 95% CI=0.39-0.88) and technique failure (adjusted HR=0.60, 95% CI=0.45-0.80). Age, diabetes (DM), nPNA and 24-hour net ultrafiltration were the risk factors for peritonitis. The subgroup analyses showed ICO delivered additional benefits for lowering the risk of peritonitis in PD patients with DM (adjusted HR=0.07 in DM vs. 0.56 in non-DM; P for interaction<0.001) and with cardiovascular diseases (CVD) (adjusted HR=0.04 in CVD vs. 0.31 in non-CVD; P for interaction=0.02). The protective effect of ICO on mortality was more prominent in high transporter PD patients (adjusted HR=0.16 in high transporter vs. 0.70 in non-high transporters; P for interaction=0.063). Conclusions: ICO can lower the risks of peritonitis, switching to HD, mortality and technique failure in a large group of Asian PD population. Its protective effects on mortality were more prominent in high transporter and patients with DM or CVD.