Icodextrin peritoneal dialysis solution reportedly benefits patients suffering from metabolic derangement due to
glucose load from
dialysate. However, the effects of
icodextrin on
insulin resistance and
adipocytokine profile remain unclear. Subjects comprised 14 stable patients on
peritoneal dialysis for >6 months. Their mean age was 57 +/- 11 years and the mean duration of
peritoneal dialysis was 49 +/- 30 months. Patients were classified into groups according to the index of
insulin resistance (index of homeostasis model assessment: HOMA-IR): Group A, HOMA-IR < 2.0 (n = 7); and Group B, HOMA-IR >or= 2.0 (n = 7).
Glucose peritoneal dialysis solution was subsequently switched to
icodextrin once daily during the night. Changes in HOMA-IR and
adipocytokine profiles were examined after three months. The
glucose absorption dose tended to decrease in both groups after
icodextrin introduction, with significant reductions in Group B. No changes were seen in body mass index, fluid status,
peritoneal dialysis dose, residual renal function or fasting plasma
glucose levels in either group. Plasma
insulin levels were unchanged in Group A, but decreased significantly in Group B. The index of
insulin resistance was thus unchanged in Group A (from 1.4 +/- 0.4 to 1.5 +/- 0.8) and significantly decreased in Group B (from 5.9 +/- 2.2 to 3.2 +/- 0.6; P < 0.01). Regarding plasma
adipocytokine profiles, no changes were found in plasma
leptin, tissue
necrosis factor-alpha or total
plasminogen activator inhibitor-1 levels in either group. Plasma
adiponectin levels were unchanged in Group A, but significantly increased in Group B.
Icodextrin solution could ameliorate
insulin resistance by decreasing
insulin levels due to a reduction in the
glucose load and an increase in plasma
adiponectin levels.