Manufacturers of glucose test strips reporting of an interference with icodextrin, low haematocrit and high uric acid levels.

Long-term accumulation/toxicity issues

From the outset of use of icodextrin in clinical trials, there were theoretical worries about myocardial, muscle and lens accumulation of maltose and metabolites. No convincing evidence is available to substantiate these concerns, now some six to seven years later and after many thousands of patient-years of exposure.

Other maltose-containing medicines

A complete list of medicines containing maltose is hard to obtain. One such which may well be in use in renal and haematology units (eg, for adjunctive therapy in CMV viraemia, scleroderma, congenital and acquired immunodeficiency states, Guillain Barre, multiple sclerosis, suppression of humoural rejection in organ transplantation, and thrombocytopenia) is Octagam intravenous immunoglobulin solution, in which the immunoglobulin is stabilised in 40% maltose. Similar concerns about blood-glucose monitoring, and possibly allergy, must exist for this product, but data are incomplete (and the risk must depend on the dosing, and presence of uraemia). It is interesting to report that a 4% solution of icodextrin is at an advanced stage of manufacture for the prevention of post-operative adhesions.

Maltose-based products, in particular icodextrin in peritoneal dialysis, offer specific and important advantages. It is helpful though to understand their use, their limitations and side-effects, and their place in dialysis.

A list of references is available from the administrators. Please contact via email: info@nephronline.org

Adeel Ansari, Robert MacGinley and David J A Goldsmith,
Renal Unit, 4th Floor,
Thomas Guy House,
Guy’s Hospital, London.

Correspondence: david.goldsmith@gstt.sthames.nhs.uk