Icodextrin reduces insulin resistance in non-diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH)

dc.contributorUniversidade Estadual Paulista (UNESP)
dc.creatorMoraes, Thyago Proença de
dc.creatorAndreoli, Maria Cláudia Cruz
dc.creatorCanziani, Maria Eugênia
dc.creatorSilva, Dirceu Reis da
dc.creatorCaramori, Jacqueline Costa Teixeira
dc.creatorPonce, Daniela
dc.creatorCassi, Hélio Vida
dc.creatorAndrade Bastos, Kleyton de
dc.creatorRio, Danyelle Romana Alves
dc.creatorPinto, Sergio Wyton
dc.creatorFerreira Filho, Sebastião Rodrigues
dc.creatorCampos, Ludimila Guedim de
dc.creatorOlandoski, Marcia
dc.creatorDivino-Filho, José Carolino
dc.creatorPecoits-Filho, Roberto
dc.date2015-12-07T15:31:29Z
dc.date2016-10-25T21:22:42Z
dc.date2015-12-07T15:31:29Z
dc.date2016-10-25T21:22:42Z
dc.date2015
dc.date.accessioned2017-04-06T09:27:21Z
dc.date.available2017-04-06T09:27:21Z
dc.identifierNephrology, Dialysis, Transplantation: Official Publication Of The European Dialysis And Transplant Association - European Renal Association, v. 30, n. 11, p. 1905-1910, 2015.
dc.identifier1460-2385
dc.identifierhttp://hdl.handle.net/11449/131087
dc.identifierhttp://acervodigital.unesp.br/handle/11449/131087
dc.identifier10.1093/ndt/gfv247
dc.identifier26063787
dc.identifierhttp://dx.doi.org/10.1093/ndt/gfv247
dc.identifier.urihttp://repositorioslatinoamericanos.uchile.cl/handle/2250/941627
dc.descriptionInsulin resistance is a common risk factor in chronic kidney disease patients contributing to the high cardiovascular burden, even in the absence of diabetes. Glucose-based peritoneal dialysis (PD) solutions are thought to intensify insulin resistance due to the continuous glucose absorption from the peritoneal cavity. The aim of our study was to analyse the effect of the substitution of glucose for icodextrin on insulin resistance in non-diabetic PD patients in a multicentric randomized clinical trial. This was a multicenter, open-label study with balanced randomization (1:1) and two parallel-groups. Inclusion criteria were non-diabetic adult patients on automated peritoneal dialysis (APD) for at least 3 months on therapy prior to randomization. Patients assigned to the intervention group were treated with 2L of icodextrin 7.5%, and the control group with glucose 2.5% during the long dwell and, at night in the cycler, with a prescription of standard glucose-based PD solution only in both groups. The primary end-point was the change in insulin resistance measured by homeostatic model assessment (HOMA) index at 90 days. Sixty patients were included in the intervention (n = 33) or the control (n = 27) groups. There was no difference between groups at baseline. After adjustment for pre-intervention HOMA index levels, the group treated with icodextrin had the lower post-intervention levels at 90 days in both intention to treat [1.49 (95% CI: 1.23-1.74) versus 1.89 (95% CI: 1.62-2.17)], (F = 4.643, P = 0.03, partial η(2) = 0.078); and the treated analysis [1.47 (95% CI: 1.01-1.84) versus 2.18 (95% CI: 1.81-2.55)], (F = 7.488, P = 0.01, partial η(2) = 0.195). The substitution of glucose for icodextrin for the long dwell improved insulin resistance measured by HOMA index in non-diabetic APD patients.
dc.languageeng
dc.publisherPublished by Oxford University Press on behalf of ERA-EDTA
dc.relationNephrology, Dialysis, Transplantation : Official Publication Of The European Dialysis And Transplant Association - European Renal Association
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectIcodextrin
dc.subjectInsulin resistance
dc.subjectNon-diabetic
dc.subjectPeritoneal dialysis
dc.titleIcodextrin reduces insulin resistance in non-diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH)
dc.typeOtro


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