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Nephrol Dial Transplant. 2015 Nov;30(11):1905-11. doi: 10.1093/ndt/gfv247. Epub 2015 Jun 10.

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

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School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
Division of Nephrology, Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil.
Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
Internal Medicine Department, University of Sao Paulo State, School of Medicine-UNESP, Botucatu, Brazil.
Santa Casa de Misericórdia de Curitiba, Curitiba, Brazil.
Federal University of Sergipe, Sergipe, Brazil.
Division of Nephrology, Hospital São João de Deus, Divinópolis, Brazil.
Federal University of Uberlândia, Minas Gerais, Brazil.
Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.



Insulin 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.


icodextrin; insulin resistance; non-diabetic; peritoneal dialysis

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