Comparative Pharmacology
Head-to-head clinical analysis: DIANEAL 137 W DEXTROSE 4 25 IN PLASTIC CONTAINER versus EXTRANEAL.
Peer-Reviewed Evidence
Head-to-head clinical analysis: DIANEAL 137 W DEXTROSE 4 25 IN PLASTIC CONTAINER versus EXTRANEAL.
DIANEAL 137 W/ DEXTROSE 4.25% IN PLASTIC CONTAINER vs EXTRANEAL
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Intraperitoneal administration of Dianeal with 4.25% dextrose creates an osmotic gradient across the peritoneal membrane, promoting ultrafiltration and removal of uremic toxins and excess fluid.
Extraneal (icodextrin) is a glucose polymer that acts as an osmotic agent for peritoneal dialysis. It is absorbed from the peritoneal cavity into the bloodstream and metabolized to maltose and other oligosaccharides. Its primary mechanism is to create an osmotic gradient across the peritoneal membrane, facilitating ultrafiltration and removal of waste products.
Intraperitoneal administration: 2 liters infused over 10-20 minutes, dwell time 4-6 hours, then drain over 15-20 minutes; 4 exchanges per 24 hours.
7.5% solution: 2 L intraperitoneally, dwell time 4–8 hours, up to 4 exchanges per day. For automated peritoneal dialysis: 2 L per cycle, typically 3–5 cycles overnight.
None Documented
None Documented
Dextrose: approximately 1.5–2 hours (systemic half-life in renal impairment; peritoneal equilibration half-life for dextrose in dialysate is 1–2 hours, reflecting absorption).
The terminal elimination half-life of icodextrin in plasma is approximately 19 hours (range 12-22 hours) following intraperitoneal administration for a dwell of 8-12 hours. This long half-life reflects slow metabolism and clearance, particularly relevant in patients with impaired renal function, leading to accumulation of maltose and other oligosaccharides.
Peritoneal dialysis: Dextrose is metabolized systemically and eliminated primarily as CO2. Unchanged dextrose undergoes renal elimination only in anuric patients on dialysis, with minimal biliary/fecal excretion (<2%).
Icodextrin is metabolized to maltose, maltotriose, and other oligosaccharides. After intraperitoneal administration, approximately 40% of the administered dose is absorbed systemically; the absorbed icodextrin and its metabolites are primarily eliminated by renal excretion (via glomerular filtration). In patients with residual renal function, approximately 30-40% of the absorbed dose is excreted in urine over 14 days. Biliary/fecal excretion is negligible (<1%).
Category C
Category C
Peritoneal Dialysis Solution
Peritoneal Dialysis Solution