Abstract
BackgroundPrevious meta-analyses have found several advantages of icodextrin compared with glucose in the application of peritoneal dialysis (PD), such as an improvement of peritoneal ultrafiltration during the long dwell and a reduction in episodes of uncontrolled fluid overload. However, the effect of icodextrin on patient-relevant outcomes remains unclear. This review aims to evaluate the benefits and harms of icodextrin in comparison with conventional glucose PD solution in patients with end-stage kidney disease receiving PD.MethodsRandomized controlled trials of icodextrin comparing with conventional glucose solution in patients with end-stage kidney disease who received PD will be deemed eligible. We will conduct systematic searches in MEDLINE, EMBASE, CENTRAL, Ichushi-Web, Chinese and Japanese databases, and in clinical trials registries (ClinicalTrials.gov, International Clinical Trials Registry Platform Search Portal (ICTRP), EU Clinical Trials Register, Japan Registries Network (JPRN), China’s Clinical Trial Registry (ChiCTR)). Furthermore, we will check conference proceedings and search references from relevant studies manually. Relevant pharmaceutical companies, authors, and experts will be contacted in an effort to identify further studies. We will not apply any limitations regarding language, publication status, and publication date when searching for eligible studies. The selection of studies, data extraction, and risk of bias assessment will be carried out by two independent reviewers. Data synthesis will be performed using RevMan 5 software with either a fixed effects model or random-effects model, depending on the presence of heterogeneity. For the assessment of statistical heterogeneity, I2 will be calculated. Sources of clinical heterogeneity will be evaluated through subgroup analyses. If there are ten or more studies included in the meta-analysis, we will investigate the publication bias using funnel plots and Egger’s test. The quality of the body of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.DiscussionWe assume that our systematic review will be more comprehensive compared to those published previously due to contacting the relevant pharmaceutical companies and a systematic search of published and unpublished non-English studies from China, Taiwan, and Japan.Systematic review registrationPROSPERO CRD42018096951
Highlights
Rationale Peritoneal dialysis (PD) is a major global modality for renal replacement therapy
We aim to evaluate the benefits and harms of icodextrin in comparison with conventional glucose peritoneal dialysis (PD) solution in patients with end-stage kidney disease receiving PD
We assume that our systematic review will be more comprehensive compared to the previously published ones due to contacting the relevant pharmaceutical companies and systematically searching published and unpublished non-English studies from China, Taiwan, and Japan
Summary
Rationale Peritoneal dialysis (PD) is a major global modality for renal replacement therapy. Glucose is the most commonly used osmotic agent in PD and is included in the final manufactured product in variable concentrations to meet the different ultrafiltration needs of patients. Glucose itself and especially its degradation products generated during manufacturing are toxic to the peritoneal membrane [4,5,6], resulting in inexorable peritoneal damage that functionally limits the effectiveness and longevity of PD therapy. These solutions lead to metabolic derangements such as hyperglycemia, hyperinsulinemia, and hyperlipidemia [7].
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