Kidney Week

Abstract: SA-PO452

Impact of Hydrolysis on the Change of Icodextrin Amount during Peritoneal Dialysis

Session Information

• Home Dialysis - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Stachowska-Pietka, Joanna, Instytut Biocybernetyki i Inzynierii Biomedycznej im Macieja Nalecza Polskiej Akademii Nauk, Warszawa, Mazowieckie, Poland

Joanna Stachowska-Pietka

• Waniewski, Jacek, Instytut Biocybernetyki i Inzynierii Biomedycznej im Macieja Nalecza Polskiej Akademii Nauk, Warszawa, Mazowieckie, Poland

Jacek Waniewski, PhD

• Lindholm, Bengt, Karolinska Institutet, Stockholm, Stockholm, Sweden

Bengt Lindholm, MD, PhD

Background

During peritoneal dialysis (PD), icodextrin (Ico), a mixture of glucose polymers, disappears from peritoneal cavity (PC) due to various processes: absorption (A), diffusion (D), convection (C), and hydrolysis (H) of Ico in PC leading to shortening of glucose polymers. The impact of H on amount of Ico molecules (Ico_M, mmol) and their fractions during PD was not investigated so far. We analysed changes of Ico_M in PC using three pore model (TPM) applied to clinical data.

Methods

Extended TPM, which includes hydrolysis of Ico, was applied to clinical data from 8 Ico-naïve PD patients during 16 h dwell with Ico-based solution and frequent sampling of dialysate and blood. Based on the measured polymers distribution, Ico was described by 7 fractions of different molecular weights, Tab.1. The change of Ico_M was calculated for the 16 h dwell time.

Results

The decrease of Ico_M (ΔIco_M in mmol) in dialysate was around 40% of Ico initial amount after 16-hour dwell and was mostly due to A (91% of ΔIco_M ) as the decrease due to D&C (74% of ΔIco_M) was almost counterbalanced by enhanced Ico_M caused by H (65% of ΔIco_M). For the fractions, the decrease in Ico_M was the highest for F2-F4 (88, 25 and 13% of ΔIco_M, respectively); however we observed the increase of F1 (31% of ΔIco_M), Tab.1. The impact of A, D, C and H on the decrease of F1-F7 amount is presented in Tab.1. For F1, overall amount increased (solely due to H); this increase was higher than the F1 decrease related to D, C and A, Tab.1.

Conclusion

Decrease of Ico amount from PC was mostly due to A and mainly related to the decrease of F2 amount, and to some extent also of F3-F4,whereas F1 was increased at the dwell end. The increase of F1 amount was solely due to H that greatly exceeded the F1 removal caused by A, D&C. For fractions F2 and F5, H and A have similar impact on the decrease of fraction amount, whereas for F3 and F4 the observed decrease was mostly due to A. On the contrary, H was the main contributor to the observed decrease of the fractions F6-F7 amount, while the contribution of A was smaller.