Research Information System
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, vol.20, no.12, pp.1729-1743, 2025 (SCI-Expanded, Scopus)
Background Experience with icodextrin use in children on long-term peritoneal dialysis (PD) is limited. We describe international icodextrin prescription practices and their effect on clinical outcomes: ultrafiltration, BP control, residual kidney function (RKF), technique and patient survival. Methods We included patients younger than 21 years enrolled in the International Pediatric Peritoneal Dialysis Network between 2007 and 2024, on automated PD with a daytime dwell. Outcome analysis was restricted to patients with 6 months or greater follow-up. We used propensity score matching to balance baseline differences between icodextrin and glucose groups. Long-term outcomes and survival were analyzed by longitudinal linear mixed-effects models and Cox proportional hazards models, respectively, adjusting for key covariates. Sensitivity analyses addressed the effect of missing data. Results Icodextrin was prescribed in 724 of 3573 (20.3%) patients, varying widely across world regions. Only "early-start" icodextrin (within 1 year of PD start) was associated with a significant decline in diastolic BP standard deviation score (beta=-1.31, P < 0.001) and a slower decline in RKF (beta=0.11, P = 0.002) compared with glucose use alone. "Late-starters" (starting icodextrin after >= 1 year on PD) compared with "early-starters" had more uncontrolled hypertension (38% versus 20%; P < 0.001), a higher antihypertensive agent requirement (68% versus 55%; P = 0.03) and an higher dialytic glucose exposure from baseline (5.4 versus 4.8 gm/kg per day; P = 0.05). Icodextrin use, both early and late, was independently associated with a positive linear increase in ultrafiltration sustained during follow-up compared with glucose use (beta=0.27 and beta=0.33, respectively; both P < 0.01). Peritonitis rates and dialysate leaks were similar between icodextrin and glucose groups. "Late-starters" had significantly increased risk of technique failure/death compared with "early-starters" (hazard ratio, 5.16; 95% confidence intervals, 1.57 to 17.0; P = 0.007). Conclusion Icodextrin use improves ultrafiltration, but only early compared with delayed initiation conferred a five-fold higher likelihood of technique survival, better BP control, and preservation of RKF.