A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis
Abstract Left ventricular hypertrophy is a risk factor for cardiovascular mortality in patients on peritoneal dialysis (PD). Because icodextrin has a greater ultrafiltration power compared with glucose-based solutions for long dwell, it could improve left ventricular mass by reducing fluid overload....
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| Format: | Article |
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Nature Portfolio
2022-09-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-20157-z |
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| author | Lilian Cordeiro Walther Yoshiharu Ishikawa Maria Claudia C. Andreoli Maria Eugenia F. Canziani Luiza Karla R. P. Araujo Benedito J. Pereira Hugo Abensur Rosa M. A. Moysés Rosilene M. Elias |
| author_facet | Lilian Cordeiro Walther Yoshiharu Ishikawa Maria Claudia C. Andreoli Maria Eugenia F. Canziani Luiza Karla R. P. Araujo Benedito J. Pereira Hugo Abensur Rosa M. A. Moysés Rosilene M. Elias |
| author_sort | Lilian Cordeiro |
| collection | DOAJ |
| description | Abstract Left ventricular hypertrophy is a risk factor for cardiovascular mortality in patients on peritoneal dialysis (PD). Because icodextrin has a greater ultrafiltration power compared with glucose-based solutions for long dwell, it could improve left ventricular mass by reducing fluid overload. This was a randomized clinical trial that included patients on PD recruited from 2 teaching hospitals, in Sao Paulo—Brazil. Patients were allocated to the control glucose group (GLU) or the intervention icodextrin (ICO) group. Clinical and cardiac magnetic resonance image (MRI) parameters were evaluated at baseline and 6 months after randomization. The primary outcome was the change in left ventricular mass adjusted by surface area (ΔLVMI), measured by cardiac MRI. A total of 22 patients completed the study (GLU, N = 12 and ICO, N = 10). Baseline characteristics such as age, sex, underlying disease, and time on dialysis were similar in both groups. At baseline, 17 patients (77.3%) presented with left ventricular hypertrophy with no difference between groups (p = 0.748). According to the total body water (TBW)/extracellular water (ECW) ratio, 36.8% and 80% of patients from GLU and ICO groups, respectively, were considered hypervolemic (p = 0.044). During follow-up, ΔLVMI was 3.9 g/m (− 10.7, 2.2) in GLU and 5.2 (− 26.8, 16.8) in ICO group (p = 0.651). ΔLVMI correlated with change in brain natriuretic peptide (r = 0.566, p = 0.044), which remained significant in a multiple regression analysis. The use of the icodextrin-based solution in prevalent patients on PD compared with a glucose-based solution was not able to improve LMV. A larger randomized trial with a longer follow-up period may be needed to show changes in LVM in this patient population. Trial registration: this study has been registered at ReBEC (Registro Brasileiro de Ensaios Clinicos) under the identification #RBR-2mzhmj2, available at: https://ensaiosclinicos.gov.br/pesquisador . |
| first_indexed | 2024-04-12T04:28:37Z |
| format | Article |
| id | doaj.art-2255364892e54777845e0ba90ded05b1 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-12T04:28:37Z |
| publishDate | 2022-09-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj.art-2255364892e54777845e0ba90ded05b12022-12-22T03:48:00ZengNature PortfolioScientific Reports2045-23222022-09-011211810.1038/s41598-022-20157-zA randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysisLilian Cordeiro0Walther Yoshiharu Ishikawa1Maria Claudia C. Andreoli2Maria Eugenia F. Canziani3Luiza Karla R. P. Araujo4Benedito J. Pereira5Hugo Abensur6Rosa M. A. Moysés7Rosilene M. Elias8Hospital das Clínicas HCFMUSP, Universidade de São PauloRadiologia, Instituto do Coração do HCFMUSP, Universidade de São PauloNefrologia, Universidade Federal de São Paulo (UNIFESP)Nefrologia, Universidade Federal de São Paulo (UNIFESP)Hospital das Clínicas HCFMUSP, Universidade de São PauloHospital das Clínicas HCFMUSP, Universidade de São PauloHospital das Clínicas HCFMUSP, Universidade de São PauloHospital das Clínicas HCFMUSP, Universidade de São PauloHospital das Clínicas HCFMUSP, Universidade de São PauloAbstract Left ventricular hypertrophy is a risk factor for cardiovascular mortality in patients on peritoneal dialysis (PD). Because icodextrin has a greater ultrafiltration power compared with glucose-based solutions for long dwell, it could improve left ventricular mass by reducing fluid overload. This was a randomized clinical trial that included patients on PD recruited from 2 teaching hospitals, in Sao Paulo—Brazil. Patients were allocated to the control glucose group (GLU) or the intervention icodextrin (ICO) group. Clinical and cardiac magnetic resonance image (MRI) parameters were evaluated at baseline and 6 months after randomization. The primary outcome was the change in left ventricular mass adjusted by surface area (ΔLVMI), measured by cardiac MRI. A total of 22 patients completed the study (GLU, N = 12 and ICO, N = 10). Baseline characteristics such as age, sex, underlying disease, and time on dialysis were similar in both groups. At baseline, 17 patients (77.3%) presented with left ventricular hypertrophy with no difference between groups (p = 0.748). According to the total body water (TBW)/extracellular water (ECW) ratio, 36.8% and 80% of patients from GLU and ICO groups, respectively, were considered hypervolemic (p = 0.044). During follow-up, ΔLVMI was 3.9 g/m (− 10.7, 2.2) in GLU and 5.2 (− 26.8, 16.8) in ICO group (p = 0.651). ΔLVMI correlated with change in brain natriuretic peptide (r = 0.566, p = 0.044), which remained significant in a multiple regression analysis. The use of the icodextrin-based solution in prevalent patients on PD compared with a glucose-based solution was not able to improve LMV. A larger randomized trial with a longer follow-up period may be needed to show changes in LVM in this patient population. Trial registration: this study has been registered at ReBEC (Registro Brasileiro de Ensaios Clinicos) under the identification #RBR-2mzhmj2, available at: https://ensaiosclinicos.gov.br/pesquisador .https://doi.org/10.1038/s41598-022-20157-z |
| spellingShingle | Lilian Cordeiro Walther Yoshiharu Ishikawa Maria Claudia C. Andreoli Maria Eugenia F. Canziani Luiza Karla R. P. Araujo Benedito J. Pereira Hugo Abensur Rosa M. A. Moysés Rosilene M. Elias A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis Scientific Reports |
| title | A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis |
| title_full | A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis |
| title_fullStr | A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis |
| title_full_unstemmed | A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis |
| title_short | A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis |
| title_sort | randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis |
| url | https://doi.org/10.1038/s41598-022-20157-z |
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