MO680INTERNATIONAL COMPARISONS OF ICODEXTRIN PRESCRIPTION PRACTICE AND ITS ASSOCIATION WITH FLUID REMOVAL, BLOOD PRESSURE, PATIENT AND TECHNIQUE SURVIVAL*

Abstract Background and Aims Icodextrin is designed to maintain ultrafiltration during the long dwell, especially when there a risk of increased fluid reabsorption (fast peritoneal solute transfer rate, PSTR), without need for excessive use high glucose. Randomized trials have demonstrated these benefits but are insufficiently powered investigate clear impact on survival. We aimed establish international prescription practices their relationship clinical outcomes. Method The Peritoneal Dialysis Outcomes Practice Patterns Study (PDOPPS) an prospective cohort study in collaboration with International Society Dialysis. current analysis was drawn from A/NZ, Canada, Japan, UK, US PDOPPS phases 1-2 (2014-2019). Patient demographics, comorbidities, lab measurements, clinic blood pressure, membrane function (both transport rate capacity), dialysis details, urine 24-hour volumes were captured at enrollment. Mortality permanent HD (HDT) events collected follow-up [median (IQR) = 1.1 yrs (0.6, 1.7)]. Linear logistic models used analyze association between icodextrin pressure. Cox regression, stratified by country, time enrollment (a) death (b) HDT, adjusted 13 transplant waitlisting, serum albumin, volume, facility size % APD use, phase, while accounting clustering. Results prescribed 1,929 (35%) 5,432 patients studied, this proportion differed being >44% all except US, where it 17%, within countries. Patients more likely coronary artery disease diabetes, lower residual volume function, less glucose, faster PSTR reduced capacity, been PD longer (PD vintage: median 1.19, IQR 0.50-2.76). Despite this, using achieved equivalent those glucose every level (see figure). low than compensated much greater overall higher each volume. not associated pressure (effects: 0.90 mmHg, 95% CI: -0.68, 2.47), mortality (Hazard ratio [HR] 1.01, 0.83, 1.23) HDT (HR 1.05, 0.90, 1.23). Conclusion There important national differences icodextrin, outlier, resulting volumes. These targeting efficient membranes removal may mask any potential survival advantage icodextrin.