What is the purpose of using icodextrin in PD, and when is it especially helpful?

• A. Icodextrin provides long-dwell ultrafiltration with less glucose absorption, helpful for long dwells and high transporter patients
• B. It increases glucose absorption and is best for short dwells
• C. It replaces all standard dialysate and is used for all dwells
• D. It has no role in PD and is used only in hemodialysis

Answer: (A)

Icodextrin works by providing a sustained osmotic gradient for ultrafiltration during long PD dwells. In standard glucose-based dialysate, the osmotic pressure drives water removal, but over a long dwell the glucose is gradually absorbed, the gradient drops, and ultrafiltration can level off—especially in patients with high peritoneal transport rates. Icodextrin is a large glucose polymer that remains in the peritoneal cavity longer and is absorbed slowly, so the osmotic force persists and fluid is reliably drawn into the dialysate throughout the entire dwell. Because it isn’t absorbed as quickly, there’s less glucose entering the bloodstream, which helps with glucose load and metabolic concerns.

This approach is especially helpful for long dwells, such as overnight or extended daytime exchanges, and for patients with high transporter status who would otherwise have inadequate ultrafiltration with glucose-based solutions. It’s not intended to replace all standard dialysate or to be used for short dwells, and it’s used within PD regimens rather than in hemodialysis.