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Wang R, Skoufos L, Martis L. Glucose Monitoring for Diabetic Patients Using Icodextrin. Perit Dial Int 2020. [DOI: 10.1177/089686080402400316] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Run Wang
- PD Solution R&D Renal Division, Baxter Healthcare McGaw Park, Illinois, USA
| | - Line Skoufos
- PD Solution R&D Renal Division, Baxter Healthcare McGaw Park, Illinois, USA
| | - Leo Martis
- PD Solution R&D Renal Division, Baxter Healthcare McGaw Park, Illinois, USA
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García–López E, Anderstam B, Heimbürger O, Amici G, Werynski A, Lindholm B. Determination of High and Low Molecular Weight Molecules of Icodextrin in Plasma and Dialysate, Using Gel Filtration Chromatography, in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080502500213] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to apply high performance liquid chromatography (HPLC) with modern gel filtration media to determine high molecular weight (HMW) icodextrin fractions and low molecular weight (LMW) icodextrin metabolites in dialysate and plasma in peritoneal dialysis (PD) patients on treatment with icodextrin, and to explore the potential relationships between these compounds, α-amylase activity, and glomerular filtration rate. Design Retrospective study of dialysate and plasma samples from PD patients. Setting Samples were collected at one PD center. Patients Blood and dialysate samples were obtained from PD patients who were subdivided into three groups: patients using only glucose-based peritoneal dialysis fluid (GPDF; GLU group, n = 23), patients studied after the first long dwell with icodextrin-based peritoneal dialysis fluid (IPDF; 1st ICO group, n = 24), and patients who were regular users of IPDF for the long dwells (ICO group, n = 9). Methods LMW icodextrin metabolites [ i.e., maltose (G2), maltotriose (G3), maltotetraose (G4), maltopentaose (G5), maltohexaose (G6), and maltoheptaose (G7)] and HMW fractions were determined in plasma and dialysate using two different gel filtration HPLC methods. Enzymatic hydrolysis with amyloglucosidase to glucose yielded the total carbohydrate content and this was used to validate the HPLC results. α-Amylase activity was determined using a routine method. Results The results obtained by gel filtration HPLC yielded values of LMW metabolites and HMW fractions in plasma and dialysate in agreement with results obtained with enzymatic hydrolysis. HMW fractions were not detectable in plasma. Absorption of icodextrin from the peritoneal cavity during the long dwell (10 – 16 hours) was, on average, 39% of the amount instilled. During the long dwell, there was a relative decrease in the dialysate concentration of the largest HMW fractions (>21.4 kDa). Plasma concentration of the LMW icodextrin metabolites G2–G7 was highest in the ICO group (2.65 ± 0.54 mg/mL) but also higher in the 1st ICO group (1.97 ± 0.57 mg/mL) compared with the GLU group (0.52 ± 0.23 mg/mL). Plasma α-amylase activity was significantly lower in the 1st ICO group and in the ICO group compared with the GLU group. Conclusions Accurate analysis of HMW icodextrin fractions in dialysate and LMW icodextrin metabolites in plasma and dialysate in PD patients can be achieved by gel filtration HPLC with two different columns. This method can be used to study the complex pattern of changes in icodextrin and its metabolites in plasma and dialysate. The finding that HMW icodextrin fractions were not detected in plasma was unexpected, and differs from results of previous studies by other researchers.
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Affiliation(s)
- Elvia García–López
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Björn Anderstam
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Olof Heimbürger
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Gianpaolo Amici
- Nephrology and Dialysis Division, Regional Hospital S. Maria dei Battuti, Treviso, Italy
| | - Andrzej Werynski
- Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
| | - Bengt Lindholm
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Faller B, Shockley T, Genestier S, Martis L. Polyglucose and Amino Acids: Preliminary Results. Perit Dial Int 2020. [DOI: 10.1177/089686089701702s12] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Ty Shockley
- Baxter Healthcare, McGaw Park, Illinois, U.S.A
| | | | - Leo Martis
- Baxter Healthcare, McGaw Park, Illinois, U.S.A
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Bouchi R, Babazono T, Inoue A, Tanaka M, Tanaka N, Hase M, Ishii A, Iwamoto Y. Icodextrin Increases Natriuretic Peptides in Diabetic Patients Undergoing CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686080602600517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ryotaro Bouchi
- Division of Nephrology and Hypertension Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
| | - Tetsuya Babazono
- Division of Nephrology and Hypertension Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
| | - Aiko Inoue
- Division of Nephrology and Hypertension Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
| | - Mizuho Tanaka
- Division of Nephrology and Hypertension Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
| | - Nobue Tanaka
- Division of Nephrology and Hypertension Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
| | - Michiyo Hase
- Division of Nephrology and Hypertension Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
| | - Akiko Ishii
- Division of Nephrology and Hypertension Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
| | - Yasuhiko Iwamoto
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo, Japan
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Kawase Y, Maeda Y, Yasuda T, Abe K, Miki T. A Simple Method to Determine Blood Concentration of Oligosaccharides in Peritoneal Dialysis Patients Using Icodextrin. Perit Dial Int 2010; 30:370-3. [DOI: 10.3747/pdi.2009.00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yoshio Kawase
- Department of Renal Failure Matsushita Memorial Hospital Moriguchi
| | - Yoichiro Maeda
- Department of Renal Failure Matsushita Memorial Hospital Moriguchi
| | - Takashi Yasuda
- Department of Urology Kyoto Prefectural University of Medicine Kyoto, Japan
| | - Koichi Abe
- Department of Urology Kyoto Prefectural University of Medicine Kyoto, Japan
| | - Tsuneharu Miki
- Department of Urology Kyoto Prefectural University of Medicine Kyoto, Japan
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6
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Affiliation(s)
- Elvia García–López
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
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Moberly JB, Mujais S, Gehr T, Hamburger R, Sprague S, Kucharski A, Reynolds R, Ogrinc F, Martis L, Wolfson M. Pharmacokinetics of icodextrin in peritoneal dialysis patients. KIDNEY INTERNATIONAL. SUPPLEMENT 2002:S23-33. [PMID: 12230479 DOI: 10.1046/j.1523-1755.62.s81.5.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED Pharmacokinetics of icodextrin in peritoneal dialysis patients. BACKGROUND Icodextrin is a glucose polymer osmotic agent used to provide sustained ultrafiltration during long peritoneal dialysis (PD) dwells. A number of studies have evaluated the steady-state blood concentrations of icodextrin during repeated use; however, to date the pharmacokinetics of icodextrin have not been well studied. The current study was conducted to determine the absorption, plasma kinetics and elimination of icodextrin and metabolites following a single icodextrin exchange. METHODS Thirteen PD patients were administered 2.0 L of solution containing 7.5% icodextrin for a 12-hour dwell. Icodextrin (total of all glucose polymers) and specific polymers with degrees of polymerization ranging from two to seven (DP2 to DP7) were measured in blood, urine and dialysate during the dwell and after draining the solution from the peritoneal cavity. RESULTS A median of 40.1% (60.24 g) of the total administered dose (150 g) was absorbed during the 12-hour dwell. Plasma levels of icodextrin and metabolites rose during the dwell and declined after drain, closely corresponding to the one-compartment pharmacokinetic model assuming zero-order absorption and first-order elimination. Peak plasma concentrations (median C peak = 2.23 g/L) were observed at the end of the dwell (median Tmax = 12.7 h) and were significantly correlated with patients' body weight (R2 = 0.805, P < 0.001). Plasma levels of icodextrin and metabolites returned to baseline within 3 to 7 days. Icodextrin had a plasma half-life of 14.73 hours and a median clearance of 1.09 L/h. Urinary excretion of icodextrin and metabolites was directly related to residual renal function (R2 = 0.679 vs. creatinine clearance, P < 0.01). In the nine patients with residual renal function, the average daily urinary excretion of icodextrin was 473 +/- 77 mg per mL of endogenous renal creatinine clearance. Icodextrin metabolites DP2 to DP4 were found in the dialysate of subsequent dextrose exchanges, contributing to their elimination from blood. Changes in intraperitoneal concentrations of icodextrin metabolites during the dwell revealed a dual pattern, with a progressive rise in the dialysate concentration of smaller polymers (DP2 to DP4) and a progressive decline in the dialysate concentrations of the larger polymers (DP5 to DP7), suggesting some intraperitoneal metabolism of the glucose polymers. This increase in dialysate metabolite levels, however, did not contribute significantly to dialysate osmolality. In addition, some diffusion of maltose (DP2) from blood to dialysate may have occurred. There were no changes in serum insulin or glucose levels during icodextrin administration, indicating that icodextrin does not result in hyperglycemia or hyperinsulinemia as occurs during dextrose-based dialysis. Serum sodium and chloride declined in parallel with the rise in plasma levels of icodextrin, supporting the hypothesis that these electrolyte changes are the result of the increased plasma osmolality due to the presence of icodextrin metabolites. CONCLUSIONS The pharmacokinetics of icodextrin in blood following intraperitoneal administration conforms to a simple, single-compartment model that can be approximated by zero-order absorption and first-order elimination. A small amount of intraperitoneal metabolism of icodextrin occurs but does not contribute significantly to dialysate osmolality. The metabolism of absorbed icodextrin and the resultant rise in plasma levels of small glucose polymers (DP2 to DP4) do not result in hyperglycemia or hyperinsulinemia, but may result in a small decrease in serum sodium and chloride.
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Affiliation(s)
- James B Moberly
- Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois 60085-6730, USA
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Plum J, Gentile S, Verger C, Brunkhorst R, Bahner U, Faller B, Peeters J, Freida P, Struijk DG, Krediet RT, Grabensee B, Tranaeus A, Filho JCD. Efficacy and safety of a 7.5% icodextrin peritoneal dialysis solution in patients treated with automated peritoneal dialysis. Am J Kidney Dis 2002; 39:862-71. [PMID: 11920355 DOI: 10.1053/ajkd.2002.32009] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In a randomized, prospective, multicenter study, we compared the safety, efficacy, and metabolic effects of a 7.5% icodextrin solution (Extraneal) with a 2.27% glucose solution for long dwell exchanges in patients undergoing automated peritoneal dialysis. Thirty-nine stable patients on automated peritoneal dialysis were randomized to receive either icodextrin (n = 20) or glucose 2.27% solution (n = 19). The study included a 2-week baseline period followed by a 12-week icodextrin treatment phase and a 2-week follow-up period when switching back to glucose. The average net ultrafiltration during the long dwell period was 278 +/- 43 mL/d for the icodextrin group and -138 +/- 81 mL/d for the control group (P < 0.001). The higher ultrafiltration volume with icodextrin was associated with higher creatinine (2.59 +/- 0.09 mL/min versus 2.16 +/- 0.11 mL/min) and urea (2.67 +/- 0.09 mL/min versus 2.28 +/- 0.12 mL/min) peritoneal clearances for the long dwell (both P < 0.001). Ultrafiltration rate per mass of carbohydrate absorbed was +5.2 +/- 1.2 microL/min/g in the icodextrin group and -5.5 +/- 2.8 microL/min/g in the glucose group (P < 0.001). In the icodextrin group, there was a decrease in serum sodium and chloride compared with baseline (P < 0.01). Total dialysate sodium removal increased in the icodextrin group from 226.7 mEq to 269.6 mEq (week 12, P < 0.001). Serum alpha-amylase activity decreased from 103 U/L to 16 U/L (P < 0.001). The total icodextrin plasma levels reached a steady-state concentration of 6,187 +/- 399 mg/L after 1 week of treatment. Urine volume and residual renal function were not specifically affected by icodextrin compared with glucose. None of the laboratory changes resulted in any reported clinically meaningful side effect. Icodextrin produced increased, sustained ultrafiltration during the long dwell period, increasing (convective) peritoneal clearance and sodium removal in automated peritoneal dialysis patients.
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Affiliation(s)
- Joerg Plum
- Department of Nephrology and Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany.
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Jörres A. Innovative approaches to the preservation of the peritoneal membrane: from bench to bedside. ADVANCES IN RENAL REPLACEMENT THERAPY 2001; 8:164-72. [PMID: 11533917 DOI: 10.1053/jarr.2001.26349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The functional integrity of the peritoneal membrane is of critical importance for the long-term success of peritoneal dialysis therapy. In addition to water and solute transport properties, the function of the membrane encompasses complex interactions with immune cells, invading microorganisms, and dialysis fluid components. During chronic peritoneal dialysis, intraperitoneal homeostasis is threatened by the repeated exposure to an unphysiologic environment that is created by the instilled solutions. Whereas their acidic pH and hyperosmolality were shown to primarily induce alterations of acute cell function, long-term peritoneal function might be affected by the repeated exposure to high concentrations of glucose and glucose degradation products. In addition to their intrinsic toxicity, these might induce or accelerate glycation processes, such as formation and deposition of advanced glycation end products in the peritoneal membrane. Presently, a new generation of dual-chambered peritoneal dialysis solutions combining the advantages of neutral pH and reduced glucose degradation products content is being introduced into clinical practice. In addition to an improved in vitro biocompatibility profile, emerging clinical trials of these novel solutions indicate that they might also improve the host defense status, membrane transport characteristics, ultrafiltration capacity, and effluent markers of peritoneal membrane integrity, while being safe and effective in correcting uremic acidosis and providing relief of inflow pain. Overall, these findings suggest that these new dialysis solutions might constitute an important step toward better preservation of long-term peritoneal membrane function during peritoneal dialysis.
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Affiliation(s)
- A Jörres
- Department of Nephrology and Medical Intensive Care, Universitätsklinikum Charité, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, Germany.
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Baldwin RP. Electrochemical determination of carbohydrates: enzyme electrodes and amperometric detection in liquid chromatography and capillary electrophoresis. J Pharm Biomed Anal 1999; 19:69-81. [PMID: 10698569 DOI: 10.1016/s0731-7085(98)00135-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In recent years, electrochemical detection (EC) methods have become increasingly important for the determination of carbohydrate compounds in a variety of biological and pharmaceutical samples. In this work, recent advances in the design and application of EC approaches are reviewed, with the goal of providing the non-electrochemist with a basic understanding of the most important EC approaches to carbohydrate detection and an overview of their current applications. Two specific EC detection strategies are considered in detail: enzyme electrodes and electrodes used for HPLC or capillary electrophoresis detection.
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Affiliation(s)
- R P Baldwin
- Department of Chemistry, University of Louisville, KY 40292, USA.
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