Letter to the Editor
Skin reactions with the use of icodextrin in peritoneal dialysis patients
Reacciones cutáneas debido al uso de icodextrina en pacientes en diálisis peritoneal
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=> "belvizcaino@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sandra" "apellidos" => "Beltrán Catalán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Pablo" "apellidos" => "Molina Vila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Mercedes" "apellidos" => "Gonzalez Moya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Lucero" "apellidos" => "Noguera-Morel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Luís Manuel" "apellidos" => "Pallardó Mateu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reacciones cutáneas debido al uso de icodextrina en pacientes en diálisis peritoneal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 82597 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Palms of the hands.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Icodextrin is a starch-derived glucose polymer which is metabolised into maltose. Its use in peritoneal dialysis (PD) has been an alternative to glucose as an osmotic agent, obtaining greater ultrafiltration (UF) for long dwells.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Icodextrin is generally well tolerated by patients, but skin reactions associated with its use have been reported. We present our experience with two patients who had skin reactions to icodextrin.</p><p id="par0015" class="elsevierStylePara elsevierViewall">First case: a 73-year-old woman with chronic renal failure secondary to interstitial nephritis due to recurrent urinary tract infections. She had a history of severe toxicoderma caused by furosemide. She started PD in November 2013. After two years on PD, icodextrin was added to increase the UF. Seven days later, the patient consulted with generalised pruritus, poor general condition, sensation of dysthermia and the development of confluent desquamating maculopapular exanthema, mainly in inframammary folds (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She had no limb involvement or mucosal lesions. The patient was diagnosed with drug-induced toxicity and it was decided to withdraw the icodextrin, replacing it with 2.3% glucose. Dermatology performed epicutaneous allergy tests on icodextrin which came back negative. Seven days after the withdrawal, there was significant improvement of the lesions on her trunk, but still residual areas of desquamation on the palms of her hands. Fourteen days after discontinuing icodextrin the patient was asymptomatic.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Second case: a 26-year-old man with no known allergies with renal failure due to episode of thrombotic microangiopathy secondary to methylmalonic acidaemia. In April 2016, he started PD from haemodialysis with three daytime 1.27% glucose exchanges and one nocturnal icodextrin exchange. After three weeks, the patient consulted with generalised pruritus, predominantly at night and the development of erythematous-desquamative lesions on the palms of his hands (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and soles of his feet, with no mucosal involvement. He was referred to dermatology and was diagnosed with drug-induced toxicoderma in the post-critical phase. In view of the possible relationship between the lesions and the use of icodextrin, it was discontinued. Fifteen days after withdrawal, the pruritus and skin lesions had disappeared.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Skin involvement associated with the use of icodextrin can present in many different ways; from localised pruritus and small desquamative areas on palms and soles<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> to generalised pruritus and exfoliative lesions affecting the trunk and extremities, which can be potentially serious.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> As a result of the diverse forms of presentation, the incidence of icodextrin-induced skin lesions ranges from 7.8%<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> to 17%<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> according to the different series reported.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The mechanism by which icodextrin causes cutaneous toxicity is not fully understood. There are suggestions that it may be the result of a type <span class="elsevierStyleSmallCaps">iv</span> hypersensitivity reaction, similar to that caused by the use of dextran solutions, given that the chemical composition of both polymers is very similar.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,4</span></a> The skin reaction usually occurs shortly after starting treatment with icodextrin, and it disappears rapidly after discontinuation.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3,4</span></a> In most situations<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2,4</span></a> withdrawal of icodextrin is necessary for complete resolution of the condition. However, where the reaction was mild, the lesions are reported to have disappeared without the need to discontinue icodextrin.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite the limitations in our two cases, as both lacked a skin biopsy, we think that nephrologists need to be aware of the risk of skin reactions associated with the use of icodextrin and their form of presentation in order to suspect them should they occur in PD patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vizcaino Castillo B, Beltrán Catalán S, Molina Vila P, Gonzalez Moya M, Noguera-Morel L, Pallardó Mateu LM. Reacciones cutáneas debido al uso de icodextrina en pacientes en diálisis peritoneal. Nefrologia. 2019;39:211–213.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 706 "Ancho" => 900 "Tamanyo" => 79637 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Inframammary folds.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 82597 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Palms of the hands.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe cutaneous hypersensitivity to icodextrin in a continuous ambulatory peritoneal dialysis patient" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.H. 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Estudio multicéntrico" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Pérez-Peñasco" 1 => "J.M. Martínez González" 2 => "A. Guerrero" 3 => "R. Montes Martín-Herrera" 4 => "A. Ruiz" 5 => "M. Benítez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nefrología" "fecha" => "2001" "volumen" => "21" "paginaInicial" => "574" "paginaFinal" => "580" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergic reactions to the polymeric glucose-based peritoneal dialysis fluid icodextrin in patients with renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Goldsmith" 1 => "S. Jayawardene" 2 => "N. Sabharwal" 3 => "K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 7 | 18 |
| 2024 October | 87 | 47 | 134 |
| 2024 September | 84 | 52 | 136 |
| 2024 August | 92 | 72 | 164 |
| 2024 July | 101 | 47 | 148 |
| 2024 June | 100 | 45 | 145 |
| 2024 May | 107 | 34 | 141 |
| 2024 April | 76 | 32 | 108 |
| 2024 March | 93 | 1529 | 1622 |
| 2024 February | 72 | 36 | 108 |
| 2024 January | 92 | 33 | 125 |
| 2023 December | 79 | 42 | 121 |
| 2023 November | 110 | 38 | 148 |
| 2023 October | 128 | 546 | 674 |
| 2023 September | 83 | 1125 | 1208 |
| 2023 August | 116 | 28 | 144 |
| 2023 July | 84 | 23 | 107 |
| 2023 June | 69 | 22 | 91 |
| 2023 May | 87 | 167 | 254 |
| 2023 April | 52 | 19 | 71 |
| 2023 March | 74 | 26 | 100 |
| 2023 February | 64 | 20 | 84 |
| 2023 January | 53 | 27 | 80 |
| 2022 December | 94 | 45 | 139 |
| 2022 November | 79 | 45 | 124 |
| 2022 October | 92 | 44 | 136 |
| 2022 September | 81 | 26 | 107 |
| 2022 August | 82 | 52 | 134 |
| 2022 July | 62 | 54 | 116 |
| 2022 June | 53 | 37 | 90 |
| 2022 May | 93 | 34 | 127 |
| 2022 April | 95 | 54 | 149 |
| 2022 March | 112 | 58 | 170 |
| 2022 February | 69 | 49 | 118 |
| 2022 January | 106 | 34 | 140 |
| 2021 December | 88 | 43 | 131 |
| 2021 November | 77 | 24 | 101 |
| 2021 October | 103 | 54 | 157 |
| 2021 September | 79 | 32 | 111 |
| 2021 August | 72 | 37 | 109 |
| 2021 July | 64 | 36 | 100 |
| 2021 June | 70 | 30 | 100 |
| 2021 May | 64 | 49 | 113 |
| 2021 April | 183 | 53 | 236 |
| 2021 March | 77 | 42 | 119 |
| 2021 February | 80 | 35 | 115 |
| 2021 January | 47 | 19 | 66 |
| 2020 December | 42 | 15 | 57 |
| 2020 November | 39 | 13 | 52 |
| 2020 October | 29 | 20 | 49 |
| 2020 September | 51 | 23 | 74 |
| 2020 August | 41 | 21 | 62 |
| 2020 July | 42 | 13 | 55 |
| 2020 June | 52 | 22 | 74 |
| 2020 May | 48 | 15 | 63 |
| 2020 April | 49 | 15 | 64 |
| 2020 March | 46 | 11 | 57 |
| 2020 February | 88 | 44 | 132 |
| 2020 January | 54 | 32 | 86 |
| 2019 December | 53 | 24 | 77 |
| 2019 November | 25 | 15 | 40 |
| 2019 October | 46 | 9 | 55 |
| 2019 September | 30 | 11 | 41 |
| 2019 August | 30 | 7 | 37 |
| 2019 July | 34 | 25 | 59 |
| 2019 June | 48 | 24 | 72 |
| 2019 May | 90 | 32 | 122 |
| 2019 April | 79 | 71 | 150 |
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