My doctor seems to not be in favor of me switching or using extraneal vs Dianeal ( Baxter). I have been on PD for 2 yrs and want to try the Extra to help protect my membrane. I understand extra is corn based, may drop or affect your glucose levels, ( I am type II and my A1C is good). Why is there a question about using the extra? What are the down sides or risks?

I sent Dr. Moran an email at Davita with no response to date?

Is the risk your blood glucose my drop and you need to be aware?

Any advice will be appreciated.



Dear Steve

While my role here at the HDC site is primarily to answer questions relating to my area of greatest interest and ‘expertise’ … namely haemodialysis, not peritoneal dialysis - indeed, we have a true international expert in PD here (Judith Bernardini from Pittsburg, PA) who might be better placed to answer your question, especially in the US context … I can make a couple of observations regarding icodextrin (sold by Baxter in the US as Extraneal).

We use icodextrin in many of our PD patients in my unit.

We commonly use it as an overnight dwell, to lessen the exposure of the PD membrane to glucose and to advanced glycation end-products (AGE’s) that are by-products of glucose metabolism and which are known to damage (or age) the peritoneal membrane, or to enhance ultrafiltration. It is an excellent adjunctive fluid to use with Dianeal.

It costs a few cents more - one relatively minor issue - it has an uncommon side effect of rash with, sometimes, a desquamating exfoliative dermatitis of palms and soles (rare) - and it needs special care with the use of glucose monitoring test strips to ensure accurate capillary blood sugar measurements.

I would have no issue with in-building icodextrin into your regime under the advice of your specialist nephrologist.

Can I make a serious sugestion to you though … post this SAME question to Judith. you will find her at the ‘Ask the Expert’ site. she is much more able to answer this question … especially in the context of the US where availability of, and costs related to, PD fluids are somewhat different to those of other countries (like Australia).

I will ask Dori to see if Judith can give a fuller, and wiser, answer for you.

Thank you! I appreciate your quick review and response. I am seeking the best way to help save my preferred method , PD.

Dear Steve

I see no reason to be anxious re icodextrin. It is a good way, I believe, to lessen the exposure of your peritoneum to glucose and to the potential (and real) damage that it may sustain, over time, from AGEs.

I would discuss the issue further with your nephrologist, but his suggestion … and, importantly, remember that I do not know your case at all … seems a very sensible one, as far as I can see, and one with which I would feel very comfortable.

it is certainly one which is consistent with your stated aims.

Again though, ask Judith. She is Professor of Nursing from Pittsburgh, an academic PD guru of international reputation … and I am sure that she knows far more than I do about PD in the US and the value of solutions like icodextrin.

John Agar