{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:21:39Z","timestamp":1790612499851,"version":"4.1.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","funder":[{"DOI":"10.13039\/100015699","name":"Fresenius Medical Care North America","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015699","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Baxter International"},{"DOI":"10.13039\/501100021081","name":"European Rare Kidney Disease Reference Network","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100021081","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009888","name":"International Society for Peritoneal Dialysis","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009888","id-type":"DOI","asserted-by":"crossref"}]},{"name":"EU4Health Program"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2025,12]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Early icodextrin use preserved residual kidney function and improved BP versus glucose dialysate in pediatric peritoneal dialysis patients.<\/jats:p>\n <\/jats:list-item>\n \n Starting icodextrin within 1 year of commencing peritoneal dialysis reduced the risk of technique failure or death nearly five-fold versus later start.<\/jats:p>\n <\/jats:list-item>\n \n Children younger than 5 years on icodextrin had similar ultrafiltration and BP control with superior kidney function preservation versus older children.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Experience with icodextrin use in children on long-term peritoneal dialysis (PD) is limited. We describe international icodextrin prescription practices and their effect on clinical outcomes: ultrafiltration, BP control, residual kidney function (RKF), technique and patient survival.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We included patients younger than 21 years enrolled in the International Pediatric Peritoneal Dialysis Network between 2007 and 2024, on automated PD with a daytime dwell. Outcome analysis was restricted to patients with 6 months or greater follow-up. We used propensity score matching to balance baseline differences between icodextrin and glucose groups. Long-term outcomes and survival were analyzed by longitudinal linear mixed-effects models and Cox proportional hazards models, respectively, adjusting for key covariates. Sensitivity analyses addressed the effect of missing data.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Icodextrin was prescribed in 724 of 3573 (20.3%) patients, varying widely across world regions. Only \u201cearly-start\u201d icodextrin (within 1 year of PD start) was associated with a significant decline in diastolic BP standard deviation score (\n \u03b2<\/jats:italic>\n =\u22121.31,\n P<\/jats:italic>\n < 0.001) and a slower decline in RKF (\n \u03b2<\/jats:italic>\n =0.11,\n P<\/jats:italic>\n = 0.002) compared with glucose use alone. \u201cLate-starters\u201d (starting icodextrin after \u22651 year on PD) compared with \u201cearly-starters\u201d had more uncontrolled hypertension (38% versus 20%;\n P<\/jats:italic>\n < 0.001), a higher antihypertensive agent requirement (68% versus 55%;\n P<\/jats:italic>\n = 0.03) and an higher dialytic glucose exposure from baseline (5.4 versus 4.8 gm\/kg per day;\n P<\/jats:italic>\n = 0.05). Icodextrin use, both early and late, was independently associated with a positive linear increase in ultrafiltration sustained during follow-up compared with glucose use (\n \u03b2<\/jats:italic>\n =0.27 and\n \u03b2<\/jats:italic>\n =0.33, respectively; both\n P<\/jats:italic>\n < 0.01). Peritonitis rates and dialysate leaks were similar between icodextrin and glucose groups. \u201cLate-starters\u201d had significantly increased risk of technique failure\/death compared with \u201cearly-starters\u201d (hazard ratio, 5.16; 95% confidence intervals, 1.57 to 17.0;\n P<\/jats:italic>\n = 0.007).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Icodextrin use improves ultrafiltration, but only early compared with delayed initiation conferred a five-fold higher likelihood of technique survival, better BP control, and preservation of RKF.<\/jats:p>\n <\/jats:sec>\n \n Podcast<\/jats:title>\n This article contains a podcast at https:\/\/dts.podtrac.com\/redirect.mp3\/www.www.asn-online.org\/media\/podcast\/CJASN\/2025_12_18_CJASNDecember.20.12.mp3<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000000837","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T16:01:32Z","timestamp":1757433692000},"page":"1729-1743","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Early-Start Versus Late-Start Icodextrin for Children Receiving Chronic Peritoneal Dialysis"],"prefix":"10.2215","volume":"20","author":[{"given":"Priyanka","family":"Khandelwal","sequence":"first","affiliation":[{"name":"University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9058-2782","authenticated-orcid":false,"given":"Dagmara","family":"Borzych-Du\u017ca\u0142ka","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6328-9575","authenticated-orcid":false,"given":"Jonas","family":"Hofstetter","sequence":"additional","affiliation":[{"name":"University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9073-4662","authenticated-orcid":false,"given":"Bruno","family":"Ranchin","sequence":"additional","affiliation":[{"name":"H\u00f4pital Femme M\u00e8re Enfant, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Vondrak","sequence":"additional","affiliation":[{"name":"University Hospital Motol, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8185-4408","authenticated-orcid":false,"given":"Yo Han","family":"Ahn","sequence":"additional","affiliation":[{"name":"Kidney Disease Center for Children and Adolescents, Seoul National University Children's Hospital, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6008-382X","authenticated-orcid":false,"given":"Hui Kim","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem Subhi","family":"Awad","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Aljalila Children's Specialty Hospital, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8494-947X","authenticated-orcid":false,"given":"Nakysa","family":"Hooman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Aliasghar Clinical Research Development Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3945-6158","authenticated-orcid":false,"given":"Robin","family":"Erickson","sequence":"additional","affiliation":[{"name":"Starship Children's Hospital, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anabella","family":"Rebori","sequence":"additional","affiliation":[{"name":"SENIAD Montevideo, Uruguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrit","family":"Kaur","sequence":"additional","affiliation":[{"name":"Royal Manchester Children's Hospital, Manchester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep Nagehan","family":"Yuruk Yildirim","sequence":"additional","affiliation":[{"name":"Istanbul University Medical Faculty, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7593-5538","authenticated-orcid":false,"given":"Yihui","family":"Zhai","sequence":"additional","affiliation":[{"name":"Children's Hospital of Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7628-8926","authenticated-orcid":false,"given":"Jameela A.","family":"Kari","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Center of excellence, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Consolo","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1463-6005","authenticated-orcid":false,"given":"Eugene Yu-Hin","family":"Chan","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong SAR"},{"name":"Department of Paediatrics, Chinese University of Hong Kong, Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4338-1723","authenticated-orcid":false,"given":"Yok-Chin","family":"Yap","sequence":"additional","affiliation":[{"name":"Paediatric CAPD Unit, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6772-1983","authenticated-orcid":false,"given":"Maria","family":"Szczepa\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8323-5320","authenticated-orcid":false,"given":"Hee Gyung","family":"Kang","sequence":"additional","affiliation":[{"name":"Kidney Disease Center for Children and Adolescents, Seoul National University Children's Hospital, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6919-8575","authenticated-orcid":false,"given":"Kar Hui","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2771-0999","authenticated-orcid":false,"given":"Ariane","family":"Zaloszyc","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, P\u00e9diatrie 1, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley A.","family":"Warady","sequence":"additional","affiliation":[{"name":"Children's Mercy Kansas City, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7564-9937","authenticated-orcid":false,"given":"Franz","family":"Schaefer","sequence":"additional","affiliation":[{"name":"University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8501-1072","authenticated-orcid":false,"given":"Rukshana","family":"Shroff","sequence":"additional","affiliation":[{"name":"University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, United 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needs","volume":"2011","author":"Schmitt","year":"2011","journal-title":"Int J Nephrol."},{"issue":"1","key":"B7-20251219","first-page":"1","article-title":"Peritoneal dialysis in children: consider the membrane for optimal prescription","volume":"16","author":"Fischbach","year":"2005","journal-title":"Saudi J Kidney Dis Transpl."},{"issue":"7","key":"B8-20251219","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1093\/ndt\/gfs603","article-title":"Encapsulating peritoneal sclerosis in children on chronic PD: a survey from the European Paediatric Dialysis Working Group","volume":"28","author":"Shroff","year":"2013","journal-title":"Nephrol Dial Transplant."},{"issue":"10","key":"B9-20251219","first-page":"CD007554","article-title":"Biocompatible dialysis fluids for peritoneal dialysis","volume":"10","author":"Htay","year":"2018","journal-title":"Cochrane Database Syst Rev."},{"issue":"10","key":"B10-20251219","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1007\/s00467-016-3398-1","article-title":"Impact of fill volume on ultrafiltration with icodextrin in children on chronic peritoneal dialysis","volume":"31","author":"Rousso","year":"2016","journal-title":"Pediatr Nephrol."},{"issue":"5","key":"B11-20251219","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1007\/s00467-020-04598-0","article-title":"Targeting optimal PD management in children: what have we learned from the IPPN registry?","volume":"36","author":"Borzych-Duzalka","year":"2021","journal-title":"Pediatr Nephrol."},{"issue":"2 Suppl 4th Report","key":"B12-20251219","first-page":"555","article-title":"The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents","volume":"114","year":"2004","journal-title":"Pediatrics."},{"issue":"2","key":"B13-20251219","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/08968608221080586","article-title":"ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment","volume":"42","author":"Li","year":"2022","journal-title":"Perit Dial Int."},{"issue":"5","key":"B14-20251219","doi-asserted-by":"crossref","first-page":"872","DOI":"10.34067\/KID.0006922021","article-title":"International icodextrin use and Association with peritoneal membrane function, fluid removal, patient and technique survival","volume":"3","author":"Davies","year":"2022","journal-title":"Kidney360."},{"issue":"2","key":"B15-20251219","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/0896860819894058","article-title":"Icodextrin use for peritoneal dialysis in Australia: a cohort study using Australia and New Zealand Dialysis and Transplant 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glucose containing peritoneal dialysis fluid","volume":"4","author":"Lin","year":"2009","journal-title":"Clin J Am Soc Nephrol."},{"issue":"4","key":"B19-20251219","doi-asserted-by":"crossref","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."},{"issue":"6","key":"B20-20251219","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1053\/j.ajkd.2019.10.004","article-title":"Icodextrin versus glucose solutions for the once-daily long dwell in peritoneal dialysis: an enriched systematic review and meta-analysis of randomized controlled trials","volume":"75","author":"Goossen","year":"2020","journal-title":"Am J Kidney Dis."},{"issue":"3","key":"B21-20251219","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3747\/pdi.2018.00217","article-title":"Icodextrin is associated with a lower mortality rate in peritoneal dialysis patients","volume":"39","author":"Yang","year":"2019","journal-title":"Perit Dial Int."},{"issue":"2","key":"B22-20251219","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1053\/j.ajkd.2018.02.357","article-title":"In reply to 'the importance of icodextrin use for technique and patient survival in peritoneal dialysis","volume":"72","author":"See","year":"2018","journal-title":"Am J Kidney Dis."},{"issue":"3","key":"B23-20251219","doi-asserted-by":"crossref","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."},{"issue":"5","key":"B24-20251219","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1093\/ndt\/gfr580","article-title":"Effects of icodextrin on patient survival and technique success in patients undergoing peritoneal 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peritoneal dialysis population","volume":"27","author":"Boudville","year":"2007","journal-title":"Perit Dial Int."},{"issue":"3","key":"B34-20251219","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1038\/ki.2015.108","article-title":"Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis","volume":"88","author":"Ha","year":"2015","journal-title":"Kidney Int."},{"issue":"5","key":"B35-20251219","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s00467-004-1783-7","article-title":"Icodextrin re-absorption varies with age in children on automated peritoneal dialysis","volume":"20","author":"Dart","year":"2005","journal-title":"Pediatr Nephrol."},{"issue":"4","key":"B36-20251219","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1007\/s00467-022-05720-0","article-title":"Factors related to ultrafiltration volume with icodextrin dialysate use in children","volume":"38","author":"Mikami","year":"2023","journal-title":"Pediatr Nephrol."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:47:15Z","timestamp":1786369635000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000837"}},"subtitle":["Findings from the International Pediatric Peritoneal Dialysis 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