Abstract: FR-PO490
Icodextrin Toxicity in a Patient with ESKD Secondary to Multiple Myeloma
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Rospert, Daniel, The University of Texas Health Science Center at Houston, Houston, Texas, United States
- Mandayam, Sreedhar A., The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Bull, Justin, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Workeneh, Biruh, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Introduction
Icodextrin is a peritoneal dialysis solution often used in diabetic patients with difficult to control type 2 diabetes. It is reported to be safer than dextrose containing PD solutions, due to less absorption than dextrose. There are reported adverse effects, the most common being skin rashes and rare cases of other adverse effects. We present a case of icodextrin toxicity in a patient with ESRD secondary to light chain deposition disease from multiple myeloma.
Case Description
76 year old man with ESRD on peritoneal dialysis was sent for inpatient admission for hyponatremia. ESRD was secondary to light chain deposition disease related to multiple myeloma. Once declared ESRD, he opted for peritoneal dialysis with icodextrin due to difficult to control type 2 diabetes. On initial evaluation he had Na 122, calculated serum Osm 287 in the setting of azotemia and measured Osm 336 with resultant Osm gap of 49. An alcohol panel was negative and immunoglobulin levels were normal. He had elevated liver enzymes with AST 419, ALT 400, and Alk Phos 144 with a negative viral hepatitis evaluation. The constellation of metabolic abnormalities were concerning for icodextrin toxicity. He was transitioned to a mixed bag with 2.5% dextrose dialysate. His hyponatremia resolved over the course of 2 days, with improvement in liver enzymes as well resulting in diagnosis of icodextrin toxicity in the setting of multiple myeloma.
Discussion
Per manufacturer, less than 5% of patients using icodextrin dialysate develop any of hyponatremia, AST, ALT, or alkaline phosphatase. The patient reported had all four. There have been case series of patients who developed a hyperosmolar, hyponatremia as described in the patient presented. There have also been reports of hepatotoxicity related to icodextrin. To our knowledge, there has not been a reported case of icodextrin toxicity resulting in the combination of hyponatremia and transaminitis in a patient with multiple myeloma. It is unclear whether this patient’s diagnosis of multiple myeloma made him more susceptible to icodextrin toxicity, however, this case the importance of frequent metabolic evaluation in patients on icodextrin dialysate. More research is needed to determine if patients with multiple myeloma may be more susceptible to icodextrin toxicity.