Unexpected Reduction in Glucose Ultrafiltration Associated to a Continuously "Full Abdomen" Prescription After Introducing a Long Icodextrin Dwell: A Case Series.

The decline in residual renal function (RRF) and the increasing peritoneal membrane permeability often require a progressive increase in glucose concentrations and the use of icodextrin (ICO) for the long dwell to maintain adequate ultrafiltration (UF). When these strategies are no longer effective and ultrafiltration failure (UFF) develops, patients typically need to be transferred to hemodialysis (HD). We describe four cases in which the introduction of a daytime dwell with ICO was associated with an unexpected and rapid decline in glucose UF with a full abdomen (overnight in Automated Peritoneal Dialysis (APD) and daytime in Continuous Ambulatory Peritoneal Dialysis (CAPD)), which was "resolved" by reintroducing an empty abdomen for part of the day, even while maintaining ICO. The observed phenomenon seems to be less related to the specific solution used during the daytime dwell and more to the continuous 24-hour full abdomen prescription.