Abstract
We thank Dr Biblaki et al.1Biblaki D. Filopoulous V. Vlassopoulous D. Icodextrin skin rash incidence.Kidney Int. 2015; https://doi.org/10.1038/ki.2015.40Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar for their comments on our case of exfoliative dermatitis related to icodextrin.2Almiani M. Kohn O. Severe exfoliative skin rash with icodextrin.Kidney Int. 2014; 86: 449Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Indeed there is high variability in the reported incidence of icodextrin-related rash. The incidence of 10% quoted in our case report was based on a review of 840 patients (icodextrin 493, dextrose 347) from three randomized controlled studies.3Wolfson M. Orginc F. Mujais S. Review of clinical trial experience with icodextrin.Kidney Int. 2002; 62: S46-S52Abstract Full Text Full Text PDF Scopus (28) Google Scholar Whereas several publications have reported no rashes related to icodextrin,4Lin A. Qian J. Li X. et al.Randomized controlled trial of icodextrin versus glucose containing peritoneal dialysis fluid.Clin J Am Soc Nephrol. 2009; 4: 1799-1804Crossref PubMed Scopus (48) Google Scholar others have found an even higher incidence.5Wolfson M. Piraino B. Hamburger R.J. et al.A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis.Am J Kidney Dis. 2002; 40: 1055-1065Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar High variability between studies on the reported incidence of rash is also noted in the control dextrose groups, from 1 to 11.6%.4Lin A. Qian J. Li X. et al.Randomized controlled trial of icodextrin versus glucose containing peritoneal dialysis fluid.Clin J Am Soc Nephrol. 2009; 4: 1799-1804Crossref PubMed Scopus (48) Google Scholar, 5Wolfson M. Piraino B. Hamburger R.J. et al.A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis.Am J Kidney Dis. 2002; 40: 1055-1065Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar Factors accounting for variability are likely the reporting criteria and sample size, the genetic background of the study participants, and concomitant medications and exposures among others. Exfoliative dermatitis occurs in a minority of patients exposed to icodextrin, a fraction of those presenting with a rash, and has a strong temporal relationship to icodextrin exposure. It manifests early in the course of therapy and resolves within days of icodextrin discontinuation. The review by Cho et al.6Cho Y. Johnson D.W. Badve S. et al.Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials.Nephrol Dial Transplant. 2013; 28: 1899-1907Crossref PubMed Scopus (66) Google Scholar excluded exfoliative dermatitis because of inconsistent reporting across trials.
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