Regular dialysis solution vs extraneal (icodextrin) solution

[ardyce]

I have some questions for all PD patients that are using the extraneal (icodextrin) for your long dwell during the day.

1. Does the extraneal solution curtail the absorption of the dialysis solution?

2.  Does your clinic freely let you use the extraneal?  The clinic I go to does not let me use it because they say it is too expensive.  (But since I paid 10 times what I should have through my insurance for the first thirty months I do not see that the cost of extraneal should make a big difference.)

3.  Does the extraneal solution help with eliminating fibrin?

4.  If you use, do you feel like it is not quite so harsh on you peritoneum?  I have read that this extraneal soulution is suppose to preserve the peritoneum.


Thanks in advance for responsing.   
 

[Restorer]

On PD, I was with Fresenius. Since Baxter supplies the Extraneal, they were reluctant to try to get me approved for it. Eventually, it was obvious that I couldn't ultrafiltrate with the regular dextrose-based solution anymore, so they ordered Extraneal for me. Unfortunately, I ended up in the hospital with even more PD problems, and had my catheter taken out before I could use any.

The idea is that your peritoneum can't absorb the icodextrin though the main pathway it absorbs dextrose. That keeps its osmolarity high, so it can keep pulling out water without getting reabsorbed.

I don't know anything about the effects of Extraneal on fibrin, or how it treats the peritoneum. I would expect it's gentler than a high dextrose solution.

[Marina]

I have some questions for all PD patients that are using the extraneal (icodextrin) for your long dwell during the day.

1. Does the extraneal solution curtail the absorption of the dialysis solution?

2.  Does your clinic freely let you use the extraneal?  The clinic I go to does not let me use it because they say it is too expensive.  (But since I paid 10 times what I should have through my insurance for the first thirty months I do not see that the cost of extraneal should make a big difference.)

3.  Does the extraneal solution help with eliminating fibrin?

4.  If you use, do you feel like it is not quite so harsh on you peritoneum?  I have read that this suppose your peritoneum.


Thanks in advance for responsing.   
 

Although I don’t  use  extraneal,  I have  asked  about  on more  than one  ocassion.
Extraneal  is  used  for ONE  dwell  (the  longest  dwell).    It’s  often used  by  fast absorbers  because  it’s  used  out of    starch  so  it’s  not  absorbed like  dextrose.
It’s  also  used  by  some  diabetics  because  sugars  does  not  rise  as  much  as  with  dextrose.
Does it  help   help  rid of  fibrin?     You  need  heparin  for  fibrin  not the  solution itself.

  http://www.renalsource.com/extraneal/
EXTRANEAL (icodextrin) is an effective and efficient peritoneal dialysis solution for the long dwell that addresses three of the challenges of fluid management.
________________________________________
Clinical implications
•   Well suited for high-average and high transport patients
•   Proven ultrafiltration superiority over 4.25% dextrose for high-average and high transport patients
•   Less glucose impact than 4.25% dextrose

[ualberta2]

Hi Marina

I am a fast absorber and I have been using extraneal now for a while now and I can tell you the this product works well for me. Since I am a fairly fast transporter, I tend to absorb the dextrose solution on daytime long dwell (12 hours+). If I use dextrose regardless of it being 1.5 or 2.5 (i have never used 4.5), I tend to absorb 50% of it by the time I perform the intial drain at night and I can only upull off half of what I put in in the morning. Because of this, they put me on extrneal and now I get between 300-500 ml of positive UF during my initial drain at night. Please ask for this if you are absorbing the dextrose solution during the long dwell! Below are my answer to your questions:

1. Does the extraneal solution curtail the absorption of the dialysis solution?
Yes. From what I read, since extraneal is not sugar based, it does not absorb a quickly than a dextrose solution. In fact is it meant to be used on long dwell (8-16 hours). Eventually, you will begin to absorb it if you leave it in the body to long

2.  Does your clinic freely let you use the extraneal?  The clinic I go to does not let me use it because they say it is too expensive.  (But since I paid 10 times what I should have through my insurance for the first thirty months I do not see that the cost of extraneal should make a big difference.)
Yes, my clinic is GREAT. They do what is right for the patient and not so much about the bottom line. I hear that extraneal is expensive but I do not know the actual dollar difference.

3.  Does the extraneal solution help with eliminating fibrin?
No. You will still need to use heparin for this

4.  If you use, do you feel like it is not quite so harsh on you peritoneum?  I have read that this extraneal soulution is suppose to preserve the peritoneum.
Based on the conversation I had with my nurse, the extraneal solution is alot more gentler on the peritoneal than the dextrose solution and should preserve your peritoneal.

[KICKSTART]

I did PD for 6 years and did manuals for most of that time , i did 3 daytime exchanges and 1 night-time dwell using extraneal  (no worry about costs over here!) While extraneal pulls off more fluid it does not remove toxins , that is why you should always do a mix of normal exchanges as well and no it doesnt make the peritoneum last longer!

[ualberta2]

I did PD for 6 years and did manuals for most of that time , i did 3 daytime exchanges and 1 night-time dwell using extraneal  (no worry about costs over here!) While extraneal pulls off more fluid it does not remove toxins , that is why you should always do a mix of normal exchanges as well and no it doesnt make the peritoneum last longer!

Hi Kickstart..I do not know if i agree with comment about extraneal "does not remove toxins". If you are referring to toxins as urea and creatinine, based on Baxter's information and clinical trials on the extraneal, the research says it produces higher "creatinine and urea nitrogen in patients with high average or greater transport characteristics" (I have attached the Baxter info on extraneal that states otherwise).

EXTRANEAL is indicated for a single daily exchange for the long (8- to 16- hour) dwell during continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD) for the management of end-stage renal disease. EXTRANEAL is also indicated to improve (compared to 4.25% dextrose) long-dwell ultrafiltration and clearance
of creatinine and urea nitrogen in patients with high average or greater transport characteristics, as defined using the peritoneal equilibration test (PET).

[KICKSTART]

Its just what the renal nurses told us ..

[ardyce]

Thanks everyone for the replies.  I know there would be someone out there who knew.  Thanks this is such a great site!