Comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis: systematic review and meta-analysis of randomized controlled trials
Abstract Background Icodextrin enhances peritoneal filtration for patients on peritoneal dialysis (PD). However, clinically important outcomes have not yet been analyzed using authentic, objective statistical methods. The present systematic review aimed to determine the risks and benefits of icodext...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-01-01
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| Series: | Renal Replacement Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41100-019-0253-4 |
| _version_ | 1818383087270100992 |
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| author | Atsuhiro Kanno Yasushi Tsujimoto Takayuki Fujii Emi Fujikura Kimio Watanabe Hidemichi Yuasa Munekazu Ryuzaki Yasuhiko Ito Hidetomo Nakamoto |
| author_facet | Atsuhiro Kanno Yasushi Tsujimoto Takayuki Fujii Emi Fujikura Kimio Watanabe Hidemichi Yuasa Munekazu Ryuzaki Yasuhiko Ito Hidetomo Nakamoto |
| author_sort | Atsuhiro Kanno |
| collection | DOAJ |
| description | Abstract Background Icodextrin enhances peritoneal filtration for patients on peritoneal dialysis (PD). However, clinically important outcomes have not yet been analyzed using authentic, objective statistical methods. The present systematic review aimed to determine the risks and benefits of icodextrin compared with a glucose-based solution with respect to clinically important and patient-centered outcomes. Methods We systematically investigated only randomized controlled trials (RCTs) by adopting the Cochrane Database of Systematic Review (2014) and searched the CENTRAL, MEDLINE, and EMBASE databases for eligible studies reported in the literature. The quality of the evidence was assessed using the GRADE approach. Results We finally evaluated important outcomes in 13 RCTs. Icodextrin significantly decreased the number of reported episodes of uncontrolled fluid overload in four RCTs that involved 236 patients (relative risk [RR], 0.31; 95% confidence interval [CI], 0.12 to 0.82; moderate certainty evidence). However, the inclusion of icodextrin for peritoneal ultrafiltration did not significantly differ in six RCTs involving 252 patients (mean difference [MD], 186.76 mL; 95% CI, − 47.08 to 420.59; low certainty evidence). Regarding other clinically important outcomes, all-cause mortality in 10 RCTs involving 1106 patients (RR, 0.75; 95% CI, 0.33 to 1.71; low certainty evidence) and technical survival in five RCTs involving 470 patients (RR, 0.57; 95%CI, 0.29 to 1.12; low certainty evidence) were not significant. Urine volume in four RCTs involving 136 patients, residual renal function in five RCTs involving 181 patients and peritoneal function measured as the ratio of solute concentration in dialysate and plasma (D/P ratio) in two RCTs involving 105 patients were not specifically affected by icodextrin, and the results for adverse events were similar between icodextrin and glucose PD solutions. Conclusion Icodextrin could relieve uncontrolled fluid overload without adding risk. However, a significant effect on clinically relevant outcomes such as technical survival and overall patient survival was not suggested. More trials are required to increase the statistical power and to verify the value of icodextrin in clinical practice. Trial registration PROSPERO, CRD42018104360 |
| first_indexed | 2024-12-14T03:00:47Z |
| format | Article |
| id | doaj.art-c48ad1edbdad4d62ab8ad3c701991eca |
| institution | Directory Open Access Journal |
| issn | 2059-1381 |
| language | English |
| last_indexed | 2024-12-14T03:00:47Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Renal Replacement Therapy |
| spelling | doaj.art-c48ad1edbdad4d62ab8ad3c701991eca2022-12-21T23:19:31ZengBMCRenal Replacement Therapy2059-13812020-01-016111110.1186/s41100-019-0253-4Comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis: systematic review and meta-analysis of randomized controlled trialsAtsuhiro Kanno0Yasushi Tsujimoto1Takayuki Fujii2Emi Fujikura3Kimio Watanabe4Hidemichi Yuasa5Munekazu Ryuzaki6Yasuhiko Ito7Hidetomo Nakamoto8Division of Community Medicine, Tohoku Medical and Pharmaceutical UniversityDepartment of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto UniversityDepartment of Nephrology, Seirei Sakura Citizen HospitalDivision of Blood Purification, Tohoku University HospitalDepartment of nephrology, St. Luke’s International HospitalDepartment of Oral and Maxillofacial Surgery, National Hospital Organization Toyohashi Medical CenterDivision of Nephrology, Department of Internal Medicine, Tokyo Saiseikai Central HospitalDivision of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of MedicineDepartment of General Internal Medicine, Saitama Medical UniversityAbstract Background Icodextrin enhances peritoneal filtration for patients on peritoneal dialysis (PD). However, clinically important outcomes have not yet been analyzed using authentic, objective statistical methods. The present systematic review aimed to determine the risks and benefits of icodextrin compared with a glucose-based solution with respect to clinically important and patient-centered outcomes. Methods We systematically investigated only randomized controlled trials (RCTs) by adopting the Cochrane Database of Systematic Review (2014) and searched the CENTRAL, MEDLINE, and EMBASE databases for eligible studies reported in the literature. The quality of the evidence was assessed using the GRADE approach. Results We finally evaluated important outcomes in 13 RCTs. Icodextrin significantly decreased the number of reported episodes of uncontrolled fluid overload in four RCTs that involved 236 patients (relative risk [RR], 0.31; 95% confidence interval [CI], 0.12 to 0.82; moderate certainty evidence). However, the inclusion of icodextrin for peritoneal ultrafiltration did not significantly differ in six RCTs involving 252 patients (mean difference [MD], 186.76 mL; 95% CI, − 47.08 to 420.59; low certainty evidence). Regarding other clinically important outcomes, all-cause mortality in 10 RCTs involving 1106 patients (RR, 0.75; 95% CI, 0.33 to 1.71; low certainty evidence) and technical survival in five RCTs involving 470 patients (RR, 0.57; 95%CI, 0.29 to 1.12; low certainty evidence) were not significant. Urine volume in four RCTs involving 136 patients, residual renal function in five RCTs involving 181 patients and peritoneal function measured as the ratio of solute concentration in dialysate and plasma (D/P ratio) in two RCTs involving 105 patients were not specifically affected by icodextrin, and the results for adverse events were similar between icodextrin and glucose PD solutions. Conclusion Icodextrin could relieve uncontrolled fluid overload without adding risk. However, a significant effect on clinically relevant outcomes such as technical survival and overall patient survival was not suggested. More trials are required to increase the statistical power and to verify the value of icodextrin in clinical practice. Trial registration PROSPERO, CRD42018104360https://doi.org/10.1186/s41100-019-0253-4Chronic kidney diseaseFluid overloadPeritoneal filtrationAll-cause mortalityClinical practice guideline |
| spellingShingle | Atsuhiro Kanno Yasushi Tsujimoto Takayuki Fujii Emi Fujikura Kimio Watanabe Hidemichi Yuasa Munekazu Ryuzaki Yasuhiko Ito Hidetomo Nakamoto Comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis: systematic review and meta-analysis of randomized controlled trials Renal Replacement Therapy Chronic kidney disease Fluid overload Peritoneal filtration All-cause mortality Clinical practice guideline |
| title | Comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis: systematic review and meta-analysis of randomized controlled trials |
| title_full | Comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis: systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis: systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis: systematic review and meta-analysis of randomized controlled trials |
| title_short | Comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis: systematic review and meta-analysis of randomized controlled trials |
| title_sort | comparison of clinical effects between icodextrin and glucose solutions on outcomes of peritoneal dialysis systematic review and meta analysis of randomized controlled trials |
| topic | Chronic kidney disease Fluid overload Peritoneal filtration All-cause mortality Clinical practice guideline |
| url | https://doi.org/10.1186/s41100-019-0253-4 |
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