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Letters |
Departments of
1
Clinical Chemistry, and
2
Diabetes Consultation, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
a Author for correspondence. Fax 31 40 2398637; e-mail harff{at}iae.nl.
To the Editor:
The glucose polymer icodextrin has become widely used in continuous ambulatory peritoneal dialysis (CAPD) (1). Icodextrin is hydrolyzed in the systemic circulation to oligosaccharides such as maltose, maltotriose, and maltotetraose. The use of icodextrin leads to substantial concentrations of these icodextrin metabolites in the blood, where they are not normally found (2). The presence of these metabolites could have an effect on enzymatic glucose measurement. A common complication in diabetes mellitus patients is renal insufficiency, which may lead to dialysis. Patients with diabetes mellitus treated by icodextrin-CAPD are at risk for having erroneous blood glucose measurements.
To evaluate the possibility of interference of the icodextrin
metabolites in various glucose assays, glucose was measured in 2–11
sets of four heparinized blood samples (800 µL); each set was
obtained from a single specimen. These samples were supplemented with
10 µL of 9 g/L NaCl solution as a blank sample or 10 µL of a
solution of maltose, maltotriose, or maltotetraose (all sugars from
Sigma Chemical Co.), achieving final concentrations for the icodextrin
metabolites of 1.2, 1.2, and 0.6 g/L, respectively. These icodextrin
metabolite concentrations were reported to be the maximum reachable
concentrations in vivo (2). From each sample, 100 µL was
centrifuged and analyzed on a Hitachi 911 with a plasma
glucose dehydrogenase (GDH) method (Boehringer Mannheim). The whole
blood samples were analyzed using an EML 105 with a glucose oxidase
(GOD) membrane method (Radiometer), a Chiron 865 with a GOD membrane
method accompanied by a glucose reference electrode, and bedside
glucose analyzers: Accutrend Sensor with a bioamperometric GDH
method (Boehringer Mannheim), Glucocard Memory with a
bioamperometric GOD method (Menarini Diagnostics), Glucotouch with a
colorimetric GOD method (Lifescan, Johnson & Johnson), One Touch
Profile with a colorimetric GOD method (Lifescan), One Touch II with a
colorimetric GOD method (Lifescan), and Precision with a GOD method
(Medisense). The results of the samples containing icodextrin
metabolites were compared with the blank sample and expressed as a mean
difference. Interference was defined as a mean difference >0.5
mmol/L (Table 1
).
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The icodextrin metabolites showed no interference in glucose measurements by the Hitachi 911 and the Chiron 865 analyzer. The EML 105 system showed a positive interference from maltose but no interference from maltotriose or maltotetraose. The bedside glucose analyzer Accutrend Sensor showed a considerable positive interference from all three icodextrin metabolites. The Glucocard Memory showed positive interference with maltose and maltotriose in one sample; for the other sample, it registered a result of "LO" (<2.2 mmol/L). The Glucotouch and the One Touch Profile showed no interference with any of the metabolites. The One Touch II showed a positive interference for maltotriose and maltotetraose. The Precision showed an interference with maltose in one sample and slight interference with maltotriose and maltotetraose in another sample. The interference was related to the concentration of the interferent, regardless of the glucose concentration of the sample.
In conclusion, the icodextrin metabolites may cause erroneously high glucose results, depending on the analysis system used. The clinically significant effect of interference by icodextrin metabolites is the potential risk of missing the diagnosis of hypoglycemia. Moreover, in diabetic patients undergoing icodextrin-CAPD therapy, the observed icodextrin metabolite interference may lead to unexplainable fluctuations in measured glucose.
References
The following articles in journals at HighWire Press have cited this article:
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  H. R. Kroll and T. R. Maher Clinical Protocols and Conditioned Human Behavior in the Background of Inadequate Information as a Risk Factor for Development of Critical Incidents Anesth. Analg., November 1, 2007; 105(5): 1512 - 1512. [Full Text] [PDF]
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 D. A. King, R. P. Ericson, and N. W. Todd OVERESTIMATION OF BLOOD GLUCOSE DUE TO PERITONEAL DIALYSIS FLUID CONTAINING ICODEXTRIN Chest Meeting Abstracts, October 1, 2007; 132(4): 696a - 697. [Abstract] [PDF]
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J. Wurz and B. Regli In One Ear and Out the Other: Communication Barriers as a Risk Factor for Critical Incidents Anesth. Analg., June 1, 2007; 104(6): 1319 - 1321. [Full Text] [PDF]
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H. R. Kroll and T. R. Maher Significant Hypoglycemia Secondary to Icodextrin Peritoneal Dialysate in a Diabetic Patient Anesth. Analg., June 1, 2007; 104(6): 1473 - 1474. [Abstract] [Full Text] [PDF]
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 K. Dungan, J. Chapman, S. S. Braithwaite, and J. Buse Glucose Measurement: Confounding Issues in Setting Targets for Inpatient Management Diabetes Care, February 1, 2007; 30(2): 403 - 409. [Full Text] [PDF]
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 G. Schoenicke, B. Grabensee, and J. Plum Dialysis with icodextrin interferes with measurement of serum {alpha}-amylase activity Nephrol. Dial. Transplant., November 1, 2002; 17(11): 1988 - 1992. [Abstract] [Full Text] [PDF]
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