Icodextrine and Insulin Resistance in Continuous Ambulatory Peritoneal Dialysis Patients

Insulin resistance is commonly observed in uremic patients. Glucose-based peritoneal dialysis solutions have long-term metabolic complications like hyperinsulinemia, hyperlipidemia, and obesity. The purpose of this study was to examine the insulin resistance in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with standard glucose and icodextrin containing solutions. The entire non diabetic CAPD patients of our center were studied: forty-four patients in all who were on CAPD treatment for 36.2 ± 23.7 months. Twenty-seven of them (11 male and 16 female) with a mean age of 46 ± 16 years were treated with standard glucose solutions (glucose group). The other 17 patients (10 male and 7 female) with a mean age of 49 ± 16 years were treated with standard glucose solutions during the day and icodextrin dwell during the night, for a median of 12 ± 6.3 months (icodextrin group). Morning fasting serum insulin levels were 20.59 ± 17.86 in the glucose group and 10.15 ± 6.87 in the icodextrin group (p = 0.0001).

Homeostasis Model Assessment Method scores of the glucose group were significantly higher (4.8±4.1 vs 2.3± 1.7; p = 0.025) than the icodextrin group. A significant positive correlation of HOMA score with insulin, fasting plasma glucose, and triglyceride levels were found in HOMA (IR+) patients. Twenty patients of the icodextrin group (74%) and 15 patients of the glucose group (88%) were hypertensive, but there was no statistically significant difference between the two groups (p = 0.13). The groups showed no significant differences for body mass index and serum levels of glucose, total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, triglyceride, intact parathyroid hormone (iPTH), and fibrinogen. In conclusion, the use of icodextrin in the long nighttime dwell can reduce serum insulin levels and increase insulin sensitivity in CAPD patients.