Goossen K, Becker M, Marshall MR, et al. - Researchers undertook this systematic review of randomized controlled trials (RCTs), including data from investigator-initiated and industry-sponsored studies, to compare once-daily long-dwell icodextrin vs glucose in patients experiencing kidney failure and undergoing peritoneal dialysis (PD). The meta-analysis included 19 RCTs with 1,693 participants. These RCTs were identified from Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists. Icodextrin led to an improvement in ultrafiltration, indicated also by fewer episodes of fluid overload. A reduction in mortality risk was likely to be seen with icodextrin-containing PD vs glucose-only PD. Although icodextrin-containing PD was shown to result in lower peritoneal glucose absorption, this did not directly translate to alterations in fasting plasma glucose and hemoglobin A1c levels. Both groups showed similar safety outcomes and residual kidney function; the reported health-related quality-of-life and pain scores were inconclusive. Experts concluded that icodextrin for once-daily long-dwell PD affords clinical benefit for some patients, including those not meeting ultrafiltration targets and carrying risk for fluid overload.