{"id":"5f8aac4918f6","type":"article","url":"https://hartvaat.nl/2026/06/30/icodextrin-verlaagt-sterfte-en-mace-bij-dialysepatienten-met-hartfalen/","title":"Icodextrin verlaagt sterfte en MACE bij dialysepatiënten met hartfalen","title_en":"The effect of icodextrin on peritoneal dialysis patients with congestive heart failure: a time-varying exposure design and target trial emulation approach.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":[],"journal":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","doi":"10.1093/ndt/gfaf265","source_url":"https://doi.org/10.1093/ndt/gfaf265","authors":["Li-Yi Ma","Yi-Ran Tu","Ming-Jen Chan","Chan Ip Chan","Jia-Jin Chen","Cheng-Chia Lee","Victor Chien-Chia Wu","Pao-Hsien Chu","Hsiang-Hao Hsu","Chih-Hsiang Chang"],"significance":5,"published":"2026-08-02","source_date":"2026-06-30","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/obstructief-slaapapneu-en-hart/"],"congress":"","summary_en":"A retrospective cohort study of 1,800 peritoneal dialysis patients with congestive heart failure found that icodextrin use was associated with significantly lower risks of all-cause mortality (HR 0.16), cardiovascular mortality (HR 0.20), and MACE (HR 0.68). Using time-varying exposure modeling and target trial emulation, the authors suggest icodextrin improves fluid management and survival in this high-risk group, though transplantation rates were lower. These findings support prioritizing icodextrin in dialysis patients with heart failure, but prospective validation is warranted.","created":"2026-07-27T01:08:43Z","updated":"2026-08-10T10:37:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectieve cohortstudie onder 1800 peritonealdialysepatiënten met congestief hartfalen toont aan dat icodextringebruik geassocieerd wordt met een lager risico op alle-oorzaak-sterfte (HR 0,16), cardiovasculaire sterfte (HR 0,20) en MACE (HR 0,68). Met behulp van time-varying exposure modeling en target trial emulation suggereert de studie dat icodextrin de vochtbalans en overleving kan verbeteren, hoewel de transplantatiekans lager uitviel. Voor de praktijk ondersteunt dit de voorkeur voor icodextrin bij deze risicogroep, maar bevestiging in prospectieve trials blijft noodzakelijk.","abstract_original":"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."}