- Email: [email protected]
Icodextrin skin rash incidence
letter to the editor
http://www.kidney-international.org © 2015 International Society of Nephrology
Icodextrin skin rash incidence To the Editor: We read with interest the case of an exfoliative rash related to icodextrin in the August 2014 issue nephrology image section and the reported incidence of about 10%.1 Our single-center experience with this complication in 86 consecutive patients on peritoneal dialysis over a period of 20 years with 43 (17 diabetics) exposed to icodextrin (median exposure time 29 months) is of only one case of icodextrinrelated skin allergy (exfoliative rash) in a diabetic female, nine days after icodextrin initiation, resolving after solution withdrawal (incidence rate 2.3%). Skin rash incidence related to icodextrin use is variously reported up to 18.9%.2 Wolfson et al.3 metanalysis reported a higher rash incidence (10.1%) compared with controls (4.6%, Po0.003). On the opposite, in Cho et al.4 metanalysis, rash risk is not increased under icodextrin, discontinued only in up to 4.3% of patients. Icodextrin solution is an important tool in peritoneal dialysis improving ultrafiltration and reducing exposure to glucose. In our experience rash incidence was low. The wide variation in the complication’s reported incidence may represent an overestimation taking into account skin manifestations of various origins, common in uremia. 1. 2.
3. 4.
Almiani M, Kohn O. Severe exfoliative skin rash with icodextrin. Kidney Int 2014; 86: 449. Wolfson M, Piraino B, Hamburger RJ et al. A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis. Am J Kidney Dis 2002; 40: 1055–1065. Wolfson M, Ogrinc F, Mujais S. Review of clinical trial experience with icodextrin. Kidney Int Suppl 2002; 62(Suppl 81): S46–S52. Cho Y, Johnson D, Badve S et al. Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant 2013; 28: 1899–1907.
Dimitra N. Biblaki1, Vassilis C.H. Filiopoulos1 and Dimosthenis A. Vlassopoulos1 1
Nephrology Department, Sismanogleion—A, Fleming Hospital, Athens, Greece Correspondence: Dimitra N. Biblaki, Nephrology Department, Sismanogleion—A, Fleming Hospital, Athens, Melissia 151 27, Greece. E-mail: [email protected] Kidney International (2015) 87, 1258; doi:10.1038/ki.2015.40
The Authors Reply: We thank Dr Biblaki et al.1 for their comments on our case of exfoliative dermatitis related to icodextrin.2 Indeed there is high variability in the reported incidence of icodextrin-related rash. The incidence of 10% quoted in our case report was based on a review of 840 patients (icodextrin 493, dextrose 347) from three randomized controlled studies.3 Whereas several publications have reported no rashes related to icodextrin,4 others have found an even higher incidence.5 High variability between studies on the reported incidence of rash is also noted in the control 1258
dextrose groups, from 1 to 11.6%.4,5 Factors accounting for variability are likely the reporting criteria and sample size, the genetic background of the study participants, and concomitant medications and exposures among others. Exfoliative dermatitis occurs in a minority of patients exposed to icodextrin, a fraction of those presenting with a rash, and has a strong temporal relationship to icodextrin exposure. It manifests early in the course of therapy and resolves within days of icodextrin discontinuation. The review by Cho et al.6 excluded exfoliative dermatitis because of inconsistent reporting across trials. 1.
Biblaki D, Filopoulous V, Vlassopoulous D. Icodextrin skin rash incidence. Kidney Int 2015; 87: 1266. 2. Almiani M, Kohn O. Severe exfoliative skin rash with icodextrin. Kidney Int 2014; 86: 449. 3. Wolfson M, Orginc F, Mujais S. Review of clinical trial experience with icodextrin. Kidney Int 2002; 62(Suppl. 91): S46–S52. 4. Lin A, Qian J, Li X et al. Randomized controlled trial of icodextrin versus glucose containing peritoneal dialysis fluid. Clin J Am Soc Nephrol 2009; 4: 1799–1804. 5. Wolfson M, Piraino B, Hamburger RJ et al. A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis. Am J Kidney Dis 2002; 40: 1055–1065. 6. Cho Y, Johnson DW, Badve S et al. Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant 2013; 28: 1899–1907.
Orly F. Kohn1 and Mohammad M. Almiani2 1
Section of Nephrology, The University of Chicago, Chicago, Illinois, USA and Sulaiman AlHabib Medical Group, Riyadh, Saudi Arabia Correspondence: Orly F. Kohn, Section of Nephrology, The University of Chicago, 5841 S Maryland Avenue, MC 5100 Chicago, Illinois 60637, USA. E-mail: [email protected] 2
Kidney International (2015) 87, 1258; doi:10.1038/ki.2015.41
Simplified screening criteria for HNF1B analysis To the Editor: Indications for HNF1B analysis in subjects with congenital anomalies of kidneys and urinary tract (CAKUT) remain controversial and a frequently discussed subject. The large phenotypic variability and the high rate of de novo mutations partly explain this discussion. Recently, Faguer et al.1 have addressed this challenging issue by developing an exhaustive scoring system. This 17-item score contains clinical, biochemical, familial, and pathological findings in affected subjects. Although the authors claim that their score performed with a sensitivity of 98.2% and a NPV of 99%, we have some connotations to address. We recently applied the score of Faguer et al.1 in a cohort of children and adults identified with HNF1B mutations in a prospective cohort of patients with CAKUT2 and found that three patients would have been missed, as especially in children an exhaustive list of symptoms is not always (yet) present. In contrast, applying the simplified screening criteria excluding patients with unilateral abnormalities in the Kidney International (2015) 87, 1258–1264
http://www.kidney-international.org © 2015 International Society of Nephrology
Icodextrin skin rash incidence To the Editor: We read with interest the case of an exfoliative rash related to icodextrin in the August 2014 issue nephrology image section and the reported incidence of about 10%.1 Our single-center experience with this complication in 86 consecutive patients on peritoneal dialysis over a period of 20 years with 43 (17 diabetics) exposed to icodextrin (median exposure time 29 months) is of only one case of icodextrinrelated skin allergy (exfoliative rash) in a diabetic female, nine days after icodextrin initiation, resolving after solution withdrawal (incidence rate 2.3%). Skin rash incidence related to icodextrin use is variously reported up to 18.9%.2 Wolfson et al.3 metanalysis reported a higher rash incidence (10.1%) compared with controls (4.6%, Po0.003). On the opposite, in Cho et al.4 metanalysis, rash risk is not increased under icodextrin, discontinued only in up to 4.3% of patients. Icodextrin solution is an important tool in peritoneal dialysis improving ultrafiltration and reducing exposure to glucose. In our experience rash incidence was low. The wide variation in the complication’s reported incidence may represent an overestimation taking into account skin manifestations of various origins, common in uremia. 1. 2.
3. 4.
Almiani M, Kohn O. Severe exfoliative skin rash with icodextrin. Kidney Int 2014; 86: 449. Wolfson M, Piraino B, Hamburger RJ et al. A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis. Am J Kidney Dis 2002; 40: 1055–1065. Wolfson M, Ogrinc F, Mujais S. Review of clinical trial experience with icodextrin. Kidney Int Suppl 2002; 62(Suppl 81): S46–S52. Cho Y, Johnson D, Badve S et al. Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant 2013; 28: 1899–1907.
Dimitra N. Biblaki1, Vassilis C.H. Filiopoulos1 and Dimosthenis A. Vlassopoulos1 1
Nephrology Department, Sismanogleion—A, Fleming Hospital, Athens, Greece Correspondence: Dimitra N. Biblaki, Nephrology Department, Sismanogleion—A, Fleming Hospital, Athens, Melissia 151 27, Greece. E-mail: [email protected] Kidney International (2015) 87, 1258; doi:10.1038/ki.2015.40
The Authors Reply: We thank Dr Biblaki et al.1 for their comments on our case of exfoliative dermatitis related to icodextrin.2 Indeed there is high variability in the reported incidence of icodextrin-related rash. The incidence of 10% quoted in our case report was based on a review of 840 patients (icodextrin 493, dextrose 347) from three randomized controlled studies.3 Whereas several publications have reported no rashes related to icodextrin,4 others have found an even higher incidence.5 High variability between studies on the reported incidence of rash is also noted in the control 1258
dextrose groups, from 1 to 11.6%.4,5 Factors accounting for variability are likely the reporting criteria and sample size, the genetic background of the study participants, and concomitant medications and exposures among others. Exfoliative dermatitis occurs in a minority of patients exposed to icodextrin, a fraction of those presenting with a rash, and has a strong temporal relationship to icodextrin exposure. It manifests early in the course of therapy and resolves within days of icodextrin discontinuation. The review by Cho et al.6 excluded exfoliative dermatitis because of inconsistent reporting across trials. 1.
Biblaki D, Filopoulous V, Vlassopoulous D. Icodextrin skin rash incidence. Kidney Int 2015; 87: 1266. 2. Almiani M, Kohn O. Severe exfoliative skin rash with icodextrin. Kidney Int 2014; 86: 449. 3. Wolfson M, Orginc F, Mujais S. Review of clinical trial experience with icodextrin. Kidney Int 2002; 62(Suppl. 91): S46–S52. 4. Lin A, Qian J, Li X et al. Randomized controlled trial of icodextrin versus glucose containing peritoneal dialysis fluid. Clin J Am Soc Nephrol 2009; 4: 1799–1804. 5. Wolfson M, Piraino B, Hamburger RJ et al. A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis. Am J Kidney Dis 2002; 40: 1055–1065. 6. Cho Y, Johnson DW, Badve S et al. Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant 2013; 28: 1899–1907.
Orly F. Kohn1 and Mohammad M. Almiani2 1
Section of Nephrology, The University of Chicago, Chicago, Illinois, USA and Sulaiman AlHabib Medical Group, Riyadh, Saudi Arabia Correspondence: Orly F. Kohn, Section of Nephrology, The University of Chicago, 5841 S Maryland Avenue, MC 5100 Chicago, Illinois 60637, USA. E-mail: [email protected] 2
Kidney International (2015) 87, 1258; doi:10.1038/ki.2015.41
Simplified screening criteria for HNF1B analysis To the Editor: Indications for HNF1B analysis in subjects with congenital anomalies of kidneys and urinary tract (CAKUT) remain controversial and a frequently discussed subject. The large phenotypic variability and the high rate of de novo mutations partly explain this discussion. Recently, Faguer et al.1 have addressed this challenging issue by developing an exhaustive scoring system. This 17-item score contains clinical, biochemical, familial, and pathological findings in affected subjects. Although the authors claim that their score performed with a sensitivity of 98.2% and a NPV of 99%, we have some connotations to address. We recently applied the score of Faguer et al.1 in a cohort of children and adults identified with HNF1B mutations in a prospective cohort of patients with CAKUT2 and found that three patients would have been missed, as especially in children an exhaustive list of symptoms is not always (yet) present. In contrast, applying the simplified screening criteria excluding patients with unilateral abnormalities in the Kidney International (2015) 87, 1258–1264