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Randomized, cross-over, controlled, open label study. The aim of this study is to demonstrate that glucose may completely be replaced by a combination of xylitol and carnitine in the bimodal PD solution for long dwell exchange.
The use of a solution icodextrin, xylitol and carnitine (IXC) as the osmotic agent in dialysate for the long dwell exchange provides sustained ultrafiltration (UF) through colloid osmosis, allowing a consistent reduction in extracellular fluid volume without the expected fall in urine output. The other major advantage of IXC is the reduced exposure and absorption of glucose as the main osmotic agent in PD therapy. The aim of this study is to demonstrate that glucose may completely be replaced by a combination of xylitol and carnitine in the bimodal IXC-based PD solution. Compared to glucose, indeed, carnitine and xylitol are extremely stable naturally occurring compounds, even at temperatures higher than those used to steam-sterilize infusional product. As a consequence, xylitol and carnitine may represent better alternatives than glucose as an osmotic ingredient both from the manufacturing and biocompatibility standpoints. Moreover, xylitol and carnitine have an excellent safety profile and possess distinct systemic actions, which are more favorable than glucose.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| IXC Peritoneal dialysis solution | Experimental | IXC (Icodextrin, Xylitol and L-Carnitine) Peritoneal dialysis solution |
|
| Icodextrin | Active Comparator | Extraneal® (7.5% Icodextrin) Peritoneal dialysis solution |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Icodextrin, xylitol and carnitine solution for peritoneal dialysis | Drug | Patients will receive a long dwell exchange for three days. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Net-ultrafiltration | Net Ultrafiltration at 10 hours (duration of long dwell), in mL, is defined as the difference between the weight of drained volume and weight of the effluent (fill volume). | Changes from baseline value at the end of each product administration period (3 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Sodium removal | Net sodium removal will be calculated as the difference between the total amount of sodium drained at end of long dwell (10 hours) and its measure value in the dialysate at time 0 before the initial infusion. Sodium will determined by the hospital laboratory. | Calculated every day for 3 days during each product administration period. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mario Bonomini, MD | Institute of Nephrology, University of Chieti, Italy | Principal Investigator |
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| ID | Term |
|---|---|
| D007676 | Kidney Failure, Chronic |
| ID | Term |
|---|---|
| D051436 | Renal Insufficiency, Chronic |
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
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| ID | Term |
|---|---|
| D000077607 | Icodextrin |
| D014993 | Xylitol |
| D010530 | Peritoneal Dialysis |
| D015314 | Dialysis Solutions |
| ID | Term |
|---|---|
| D005936 | Glucans |
| D001704 | Biopolymers |
| D011108 | Polymers |
| D046911 | Macromolecular Substances |
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Randomized cross-over, controlled, open label.
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|
| EXTRANEAL 7.5G/100Ml Peritoneal Dialysis Solution | Drug | Patients will receive a long dwell exchange for three days. |
|
|
| Carnitine plasmatic level | Carnitine plasmatic level is assessed by chemical analysis of patient's plasma samples. | Every day for 3 days during each product administration and during the wash-out period |
| Xylitol plasmatic level | Xylitol plasmatic leve is assessed by chemical analysis of patient's plasma samples. | Every day for 3 days during each product administration and during the wash-out period. |
| Xylitol absorption | Xilitol absorption is determined by calculating the difference (in grams) between the amount of xylitol (measured by lab analysis) in plasma and the amount of xylitol in the patient's dialysis solution administered. | Every day for 3 days during each product administration |
| Adverse Events | Through study completion, an average of 21 days. |
| D052776 |
| Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011134 |
| Polysaccharides |
| D002241 | Carbohydrates |
| D013402 | Sugar Alcohols |
| D000438 | Alcohols |
| D009930 | Organic Chemicals |
| D006435 | Renal Dialysis |
| D017582 | Renal Replacement Therapy |
| D013812 | Therapeutics |
| D016060 | Sorption Detoxification |
| D019999 | Pharmaceutical Solutions |
| D012996 | Solutions |
| D004364 | Pharmaceutical Preparations |
| D045506 | Therapeutic Uses |
| D020228 | Pharmacologic Actions |
| D020164 | Chemical Actions and Uses |
| D020313 | Specialty Uses of Chemicals |