icodextrinbased

Icodextrin-based refers to peritoneal dialysis solutions in which icodextrin is used as the osmotic agent, most commonly in a 7.5% w/v solution. These products, including brand names such as Extraneal, are designed for use in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis as an alternative to glucose-containing solutions.

The osmotic mechanism relies on icodextrin, a glucose polymer derived from starch. When infused into the peritoneal cavity, it creates a sustained osmotic gradient that promotes ultrafiltration during long dwell times. Icodextrin is gradually absorbed and hydrolyzed by amylase into maltose and other dextrins, which are further metabolized to glucose in the body, providing ongoing fluid removal with less abrupt changes in osmotic strength than glucose-based solutions.

Clinical use and advantages include improved ultrafiltration during long dwells, making icodextrin-based solutions particularly helpful for patients who experience reduced UF with glucose solutions or who have high peritoneal transporter rates. They can lessen the glycemic impact and diabetes-related excursions associated with conventional glucose-containing PD fluids and support better fluid management in selected patients.

Safety and limitations involve several considerations. Some icodextrin breakdown products can interfere with certain point-of-care glucose meters, potentially giving falsely elevated glucose readings; laboratory measurements or validated meters are recommended for monitoring. Rare hypersensitivity reactions and skin irritation may occur. Caution is advised in patients with known icodextrin allergy or intolerance, and appropriate clinical judgment should guide use.