{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T03:43:49Z","timestamp":1782791029928,"version":"3.54.5"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Vantive Healthcare"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Icodextrin is an alternative peritoneal dialysis (PD) solution with favorable fluid management and metabolic properties. Given the limited evidence regarding the use of icodextrin in patients with pre-existing congestive heart failure (CHF), this study aimed to examine the association between icodextrin use and clinical outcomes in PD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the Chang Gung Research Database (CGRD), including 1800 eligible PD patients with CHF from 2005 to 2022 in Taiwan, followed through June 2023. Icodextrin users (\u226550% of PD duration) were compared with non-users. Primary outcomes included all-cause mortality, cardiovascular mortality, sudden death and major adverse cardiovascular events (MACE). Multivariable Cox proportional hazards models incorporating time-varying exposure to icodextrin were applied. To evaluate the robustness of our primary analysis, we conducted a target trial emulation framework and an alternative time-dependent data structure as sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Icodextrin use was associated with lower risks of all-cause mortality [adjusted hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.13\u20130.20], cardiovascular mortality (HR 0.20, 95% CI 0.13\u20130.30), sudden death (HR 0.15, 95% CI 0.11\u20130.19) and MACE (HR 0.68, 95% CI 0.58\u20130.80). Icodextrin users also showed associations with reduced risks of encapsulating peritoneal sclerosis and transition to hemodialysis but lower transplantation rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In PD patients with CHF, icodextrin use was independently associated with better survival and cardiovascular outcomes. These findings support its preferential use in high-risk PD populations and warrant further prospective investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf265","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T12:45:19Z","timestamp":1765629919000},"page":"1313-1321","source":"Crossref","is-referenced-by-count":0,"title":["The effect of icodextrin on peritoneal dialysis patients with congestive heart failure: a time-varying exposure design and target trial emulation approach"],"prefix":"10.1093","volume":"41","author":[{"given":"Li-Yi","family":"Ma","sequence":"first","affiliation":[{"name":"Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch Department of Nephrology, , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ran","family":"Tu","sequence":"additional","affiliation":[{"name":"Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch Department of Nephrology, , Taoyuan ,","place":["Taiwan"]},{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Jen","family":"Chan","sequence":"additional","affiliation":[{"name":"Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch Department of Nephrology, , Taoyuan ,","place":["Taiwan"]},{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan Ip","family":"Chan","sequence":"additional","affiliation":[{"name":"Medical Affairs, Vantive Healthcare Ltd ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Jin","family":"Chen","sequence":"additional","affiliation":[{"name":"Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch Department of Nephrology, , Taoyuan ,","place":["Taiwan"]},{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6973-5908","authenticated-orcid":false,"given":"Cheng-Chia","family":"Lee","sequence":"additional","affiliation":[{"name":"Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch Department of Nephrology, , Taoyuan ,","place":["Taiwan"]},{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Chien-Chia","family":"Wu","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]},{"name":"Chang Gung Memorial Hospital, Linkou Branch Department of Cardiology, , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0361-6348","authenticated-orcid":false,"given":"Pao-Hsien","family":"Chu","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]},{"name":"Chang Gung Memorial Hospital, Linkou Branch Department of Cardiology, , Taoyuan ,","place":["Taiwan"]},{"name":"Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiang-Hao","family":"Hsu","sequence":"additional","affiliation":[{"name":"Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch Department of Nephrology, , Taoyuan ,","place":["Taiwan"]},{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7293-0149","authenticated-orcid":false,"given":"Chih-Hsiang","family":"Chang","sequence":"additional","affiliation":[{"name":"Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch Department of Nephrology, , Taoyuan ,","place":["Taiwan"]},{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"2026062922473935700_bib1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: an update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int Suppl 2022"},{"key":"2026062922473935700_bib2","doi-asserted-by":"publisher","first-page":"e0158765","DOI":"10.1371\/journal.pone.0158765","article-title":"Global prevalence of chronic kidney disease\u2014a systematic review and meta-analysis","volume":"11","author":"Hill","year":"2016","journal-title":"PLoS One"},{"key":"2026062922473935700_bib3","doi-asserted-by":"publisher","first-page":"e0263534","DOI":"10.1371\/journal.pone.0263534","article-title":"Outcomes of peritoneal dialysis in elderly vs non-elderly patients: a systemic review and meta-analysis","volume":"17","author":"Jiang","year":"2022","journal-title":"PLoS One"},{"key":"2026062922473935700_bib4","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1471-2369-9-14","article-title":"Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: investigating differences in early and later years of current treatment","volume":"9","author":"Ginieri-Coccossis","year":"2008","journal-title":"BMC Nephrol"},{"key":"2026062922473935700_bib5","doi-asserted-by":"publisher","first-page":"3238","DOI":"10.1681\/ASN.2016010112","article-title":"The current state of peritoneal dialysis","volume":"27","author":"Mehrotra","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"2026062922473935700_bib6","doi-asserted-by":"publisher","first-page":"e0220800","DOI":"10.1371\/journal.pone.0220800","article-title":"Healthcare costs of patients on different renal replacement modalities\u2014analysis of Dutch health insurance claims data","volume":"14","author":"Mohnen","year":"2019","journal-title":"PLoS One"},{"key":"2026062922473935700_bib7","doi-asserted-by":"publisher","first-page":"e0297688","DOI":"10.1371\/journal.pone.0297688","article-title":"The impact of icodextrin on the outcomes of incident peritoneal dialysis patients","volume":"19","author":"Wang","year":"2024","journal-title":"PLoS One"},{"key":"2026062922473935700_bib8","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1038\/nrneph.2012.13","article-title":"An update on peritoneal dialysis solutions","volume":"8","author":"Garcia-Lopez","year":"2012","journal-title":"Nat Rev Nephrol"},{"key":"2026062922473935700_bib9","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1159\/000128608","article-title":"Initial glucose load predicts technique survival in patients on chronic peritoneal dialysis","volume":"28","author":"Wu","year":"2008","journal-title":"Am J Nephrol"},{"key":"2026062922473935700_bib10","doi-asserted-by":"publisher","first-page":"e30337","DOI":"10.1371\/journal.pone.0030337","article-title":"Safety issues of long-term glucose load in patients on peritoneal dialysis\u2014a 7-year cohort study","volume":"7","author":"Wu","year":"2012","journal-title":"PLoS One"},{"key":"2026062922473935700_bib11","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1177\/089686080102100308","article-title":"Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism","volume":"21","author":"Bredie","year":"2001","journal-title":"Perit Dial Int"},{"key":"2026062922473935700_bib12","doi-asserted-by":"publisher","first-page":"2338","DOI":"10.1097\/01.ASN.0000083904.12234.27","article-title":"Icodextrin improves the fluid status of peritoneal dialysis patients: results of a double-blind randomized controlled trial","volume":"14","author":"Davies","year":"2003","journal-title":"J Am Soc Nephrol"},{"key":"2026062922473935700_bib13","doi-asserted-by":"publisher","first-page":"1799","DOI":"10.2215\/CJN.02950509","article-title":"Randomized controlled trial of icodextrin versus glucose containing peritoneal dialysis fluid","volume":"4","author":"Lin","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026062922473935700_bib14","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1177\/089686080902900409","article-title":"Icodextrin improves metabolic and fluid management in high and high-average transport diabetic patients","volume":"29","author":"Paniagua","year":"2009","journal-title":"Perit Dial Int"},{"key":"2026062922473935700_bib15","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1177\/0896860820970097","article-title":"Favorable effects of peritoneal dialysis in patients with refractory heart failure and overhydration","volume":"42","author":"Papasotiriou","year":"2022","journal-title":"Perit Dial Int"},{"key":"2026062922473935700_bib16","doi-asserted-by":"publisher","first-page":"S67","DOI":"10.1038\/sj.ki.5001918","article-title":"Place of peritoneal dialysis in the management of treatment-resistant congestive heart failure","volume":"70","author":"Mehrotra","year":"2006","journal-title":"Kidney Int"},{"key":"2026062922473935700_bib17","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1002\/pds.4412","article-title":"Icodextrin reduces the risk of congestive heart failure in peritoneal dialysis patients","volume":"27","author":"Wang","year":"2018","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2026062922473935700_bib18","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1002\/pds.4713","article-title":"The Chang Gung Research Database-a multi-institutional electronic medical records database for real-world epidemiological studies in Taiwan","volume":"28","author":"Shao","year":"2019","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2026062922473935700_bib19","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.bj.2017.08.002","article-title":"Chang Gung Research Database: a multi-institutional database consisting of original medical records","volume":"40","author":"Tsai","year":"2017","journal-title":"Biomed J"},{"key":"2026062922473935700_bib20","doi-asserted-by":"publisher","first-page":"2044","DOI":"10.1093\/ndt\/gfr580","article-title":"Effects of icodextrin on patient survival and technique success in patients undergoing peritoneal dialysis","volume":"27","author":"Han","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"2026062922473935700_bib21","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using big data to emulate a target trial when a randomized trial is not available","volume":"183","author":"Hernan","year":"2016","journal-title":"Am J Epidemiol"},{"key":"2026062922473935700_bib22","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1177\/2632084320961043","article-title":"Causal survival analysis: a guide to estimating intention-to-treat and per-protocol effects from randomized clinical trials with non-adherence","volume":"2","author":"Murray","year":"2021","journal-title":"Res Methods Med Health Sci"},{"key":"2026062922473935700_bib23","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1111\/nep.13568","article-title":"Icodextrin is associated with a lower risk of atrial fibrillation in peritoneal dialysis patients","volume":"24","author":"Wang","year":"2019","journal-title":"Nephrology"},{"key":"2026062922473935700_bib24","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1111\/sdi.12198","article-title":"Updates on the management of diabetes in dialysis patients","volume":"27","author":"Rhee","year":"2014","journal-title":"Semin Dial"},{"key":"2026062922473935700_bib25","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.2337\/dc12-0483","article-title":"A critical evaluation of glycated protein parameters in advanced nephropathy: a matter of life or death: A1C remains the gold standard outcome predictor in diabetic dialysis patients","volume":"35","author":"Kalantar-Zadeh","year":"2012","journal-title":"Counterpoint. Diabetes Care"},{"key":"2026062922473935700_bib26","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1038\/nrneph.2015.38","article-title":"Haemodialysis-induced hypoglycaemia and glycaemic disarrays","volume":"11","author":"Abe","year":"2015","journal-title":"Nat Rev Nephrol"},{"key":"2026062922473935700_bib27","doi-asserted-by":"publisher","first-page":"708","DOI":"10.2337\/db11-1015","article-title":"Glycemic control and cardiovascular mortality in hemodialysis patients with diabetes: a 6-year cohort study","volume":"61","author":"Ricks","year":"2012","journal-title":"Diabetes"},{"key":"2026062922473935700_bib28","doi-asserted-by":"publisher","first-page":"110016","DOI":"10.1016\/j.diabres.2022.110016","article-title":"Glycated hemoglobin levels and risk of all-cause and cause-specific mortality in hemodialysis patients with diabetes","volume":"190","author":"Kim","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"2026062922473935700_bib29","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s11255-017-1647-2","article-title":"Icodextrin and peritoneal dialysis: advantages and new applications","volume":"50","author":"Dousdampanis","year":"2018","journal-title":"Int Urol Nephrol"},{"key":"2026062922473935700_bib30","doi-asserted-by":"publisher","first-page":"S48","DOI":"10.1177\/089686080002005S09","article-title":"Biocompatibility of new peritoneal dialysis solutions: clinical experience","volume":"20","author":"Garcia-Lopez","year":"2000","journal-title":"Perit Dial Int"},{"key":"2026062922473935700_bib31","doi-asserted-by":"crossref","first-page":"S106","DOI":"10.1177\/089686080002002S21","article-title":"Assessment of the effectiveness, safety, and biocompatibility of icodextrin in automated peritoneal dialysis. The Dextrin in APD in Amsterdam (DIANA) Group","volume":"20","author":"Posthuma","year":"2000","journal-title":"Perit Dial Int"},{"key":"2026062922473935700_bib32","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1016\/j.ajpath.2017.03.007","article-title":"miR-21 promotes fibrogenesis in peritoneal dialysis","volume":"187","author":"Lopez-Anton","year":"2017","journal-title":"Am J Pathol"},{"key":"2026062922473935700_bib33","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1093\/ndt\/gfq086","article-title":"Effects of icodextrin on the peritoneal membrane","volume":"25","author":"Krediet","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"2026062922473935700_bib34","doi-asserted-by":"publisher","first-page":"2521","DOI":"10.1681\/ASN.2014090939","article-title":"Interstitial fibrosis restricts osmotic water transport in encapsulating peritoneal sclerosis","volume":"26","author":"Morelle","year":"2015","journal-title":"J Am Soc Nephrol"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfaf265\/65876730\/gfaf265.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/41\/7\/1313\/65876730\/gfaf265.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/41\/7\/1313\/65876730\/gfaf265.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T02:47:45Z","timestamp":1782787665000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/41\/7\/1313\/8379437"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,13]]},"references-count":34,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,12,13]]},"published-print":{"date-parts":[[2026,6,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfaf265","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2025,12,13]]}}}