Hi Mr. Kumar, an excellent review on the usefulness of icodextrin exchanges 2 times has been published by the working group of Joanne Bargman / Toronto this year. (Int J Nephrol, Vol 2013, Article ID 424915). Regards!

There are experiences using successfully icodextrin two times a day, but this need is per se an alert of the bad conditions of peritoneum. It is opportune to remind two aspects of this topic : 1) A wide literature has shown the important damage of peritoneum due to icodextrin 2) There is some alerst concerning a possible increase of encapsulating peritoneal sclerosis incidence and a paper ( Kawanishi H, Shintaku S, Shishida M, Morrishi M, Tsuchiya S, Dohi K. A case of encapsulating peritoneal sclerosis suspected to result from the use of icodextrin peritoneal solutions Adv Perit Dial 2009;25: 45 - 49 ) reported a case where it is possible to suspect the direct responsibility of icodextrin in peritoneal sclerosis happening . Taking into account the points 1 and 2 , I think that a patient needing two exchanges a day of icodextrin should be switched to extracorporeal treatment, and going on PD because the only possible treatment , with a tight following up of peritoneum conditions to eventually start a timely pharmacological treatment

Somewhat agree with Giancarlo excellent response beside some of my patients had bad rash and episodes of hypertension. Also should consider FDA recent warning for falsely affecting FSBS results when using many of commercially available glucometers

The false results concerning the level of glicemia is something complicating the use of icodextrin but not necessarily suggesting to to leave or to avoid its use. The fundamental base of a very cautiuos use of icodextrin is its undeniable peritoneal damage as well as also the possible sistemic inflammatory reactions as experienced by Elsam.. Consequently I remain in the idea that the use of icodextrin two times a day should be a very temporary use limited to patients needing to rapidly correct an harmful overweight and not a clinical standard schedule.

We did it in a few pediatric patients, when 1) PD was the only RRT option 2) we were not able to achieve the necessary minimum UF. We perform the routine daily use of Extraneal from 1998 in ALL pediatric PD patients - no complications ever recorded. Unfortunately, can not speculate on long-term results, since our kids are usually transplanted very quickly (few months max).

Dear Dr Strazdins, you quotes in the last sentence of your intervention the reason by which you di not experience the peritoneal damages quoted in my last intervention and in a sufficiently wide literature : your little patients are very quickly transplanted and so you cannot see the very difficult situation possibly noticed in transplanted adults few months after the transplant

Dear Giancarlo, you're most probably correct - the short Icodextrin exposure causing the lack of side-effects in our population. Meanwhile I am trying to find what happens with our adult patients - will report, if successful. Happy New Year! Vladimirs