Icodextrin verlaagt sterfte en MACE bij dialysepatiënten met hartfalen

BACKGROUND: 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. METHODS: 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 (≥50% 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. RESULTS: Icodextrin use was associated with lower risks of all-cause mortality [adjusted hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.13-0.20], cardiovascular mortality (HR 0.20, 95% CI 0.13-0.30), sudden death (HR 0.15, 95% CI 0.11-0.19) and MACE (HR 0.68, 95% CI 0.58-0.80). Icodextrin users also showed associations with reduced risks of encapsulating peritoneal sclerosis and transition to hemodialysis but lower transplantation rates. CONCLUSIONS: 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.