Icodextrin

Icodextrin is a glucose polymer derived from starch that functions as an osmotic agent in medical and industrial applications. Chemically, it consists of high‑molecular‑weight dextrin chains linked primarily by α‑1,4‑glycosidic bonds, with a molecular weight range of 12,000–16,000 Da. Because the polymer is too large to be absorbed across most biological membranes, it remains in the extracellular space for prolonged periods, creating a sustained osmotic gradient.

In clinical practice, icodextrin is most widely used as a biocompatible solution for peritoneal dialysis (PD). When added to dialysis fluid, it replaces glucose to provide continuous ultrafiltration over long dwell times, typically 12–16 hours. This reduces the risk of glucose‑related metabolic complications, such as hyperglycemia and the development of peritoneal membrane changes associated with high‑glucose exposure. Icodextrin‑based solutions have been shown to improve fluid removal in patients with high transport membranes and to be comparable to glucose solutions with respect to solute clearance.

Beyond dialysis, icodextrin is employed in pharmaceutical formulations as a stabilizer and carrier for controlled‑release drug delivery, and in food technology as a soluble fiber with low caloric value. Its resistance to rapid enzymatic degradation makes it useful for creating viscosity‑modifying agents and for masking taste.

Safety data indicate that icodextrin is generally well tolerated. Adverse effects are uncommon but may include skin reactions, allergic responses, and, rarely, peritoneal inflammation. Patients with known maltodextrin or starch allergies are advised to avoid icodextrin‑containing products. Ongoing research explores its potential in novel drug‑delivery systems and as a component of bio‑engineered scaffolds.