Clinical benefits of icodextrin-based peritoneal dialysis solution and its impact on cardiovascular risk in patients undergoing peritoneal dialysis

doi:10.3969/j.issn.1674-8115.2026.06.008

Abstract

Abstract:

Objective ·To evaluate the clinical benefits of icodextrin-based peritoneal dialysis solution (ICO) in patients undergoing peritoneal dialysis (PD), and analyze its impact on the incidence of major adverse cardiovascular events (MACE). Methods ·This multicenter, prospective, and randomized controlled trial enrolled 120 patients undergoing PD from three clinical centers between January 2023 and January 2024. The participants were randomly assigned in a 1:2 ratio to the ICO group (n=40) or the control group (n=80). Patients in the ICO group received 1.5% or 2.5% glucose-based PD solution during the day and a nightly 8‒12 h dwell of 7.5% ICO. Patients in the control group received 1.5% or 2.5% glucose-based PD solution during the day and a once-daily 8‒12 h dwell of 2.5% glucose-based PD solution. The intervention period was 12 months. Demographic data of the patients were collected, as well as laboratory parameters, overhydration (OH) values, peritoneal equilibration test results, and echocardiographic parameters before and after the intervention. The incidences of MACE, hospitalization, and death were recorded in both groups. Kaplan-Meier survival curves were used to compare the differences in MACE incidence, hospitalization rate, all-cause mortality, and cardiovascular mortality between the two groups. Multivariable Cox regression analysis was performed to identify factors associated with MACE in patients undergoing PD. Results ·After 12 months of intervention, the ICO group showed significantly lower levels of fasting blood glucose, glycated hemoglobin, body mass index, OH values, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) compared with the control group (all P<0.05). The ICO group also had significantly higher 24-h ultrafiltration volume, residual renal Kt/V (r-Kt/V), and total Kt/V (t-Kt/V) than the control group (all P<0.05). Echocardiographic data revealed that the ICO group had significantly lower left ventricular end-diastolic diameter (LVEDd) and left ventricular mass index (LVMI) (both P<0.05), and significantly higher left ventricular ejection fraction (LVEF) (P<0.05) compared with the control group. Kaplan-Meier survival analysis showed that the ICO group had significantly lower cardiovascular mortality (Log-rank P=0.048) and MACE incidence (Log-rank P=0.043) than the control group. No significant differences were observed in all-cause mortality or hospitalization rate between the two groups. Multivariable Cox regression analysis identified pre-existing cardiovascular disease (HR=1.57, 95%CI 1.07‒2.33, P=0.035), high peritoneal transport status (HR=1.65, 95%CI 1.08‒2.89, P=0.045), and elevated NT-proBNP levels (HR=1.38, 95%CI 1.13‒2.89, P=0.013) as independent risk factors for MACE in patients undergoing PD, while the use of ICO (HR=0.35, 95%CI 0.17‒0.89, P=0.012) was identified as a protective factor. Conclusion ·ICO improves glucose metabolism, alleviates volume overload, enhances dialysis adequacy, and reduces the incidence of MACE and cardiovascular mortality in patients undergoing PD.

Key words: icodextrin-based peritoneal dialysis solution, peritoneal dialysis, major adverse cardiovascular event (MACE), risk factor

CLC Number:

R692.5

Feng Linhong, Wu Di, Zhu Yingchun, Xu Jiarui, Zhang Chong, Wang Yakun. Clinical benefits of icodextrin-based peritoneal dialysis solution and its impact on cardiovascular risk in patients undergoing peritoneal dialysis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(6): 759-769.

Figures/Tables 7

TrendMD

References 37

[1]	Goossen K, Becker M, Marshall M R, et al. Icodextrin versus glucose solutions for the once-daily long dwell in peritoneal dialysis: an enriched systematic review and meta-analysis of randomized controlled trials[J]. Am J Kidney Dis, 2020, 75(6): 830-846.
[2]	Himmelfarb J, Vanholder R, Mehrotra R, et al. The current and future landscape of dialysis[J]. Nat Rev Nephrol, 2020, 16(10): 573-585.
[3]	Ahmad M, Shah H, Pliakogiannis T, et al. Prevention of membrane damage in patient on peritoneal dialysis with new peritoneal dialysis solutions[J]. Int Urol Nephrol, 2007, 39(1): 299-312.
[4]	Olszowska A, Waniewski J, Stachowska-Pietka J, et al. Long peritoneal dialysis dwells with icodextrin: kinetics of transperitoneal fluid and polyglucose transport[J]. Front Physiol, 2019, 10: 1326.
[5]	Kunin M, Beckerman P. The peritoneal membrane: a potential mediator of fibrosis and inflammation among heart failure patients on peritoneal dialysis[J]. Membranes, 2022, 12(3): 318.
[6]	Grzywacz A, Lubas A, Smoszna J, et al. Risk factors associated with all-cause death among dialysis patients with diabetes[J]. Med Sci Monit, 2021, 27: e930152.
[7]	Chang T I, Ryu D R, Yoo T H, et al. Effect of icodextrin solution on the preservation of residual renal function in peritoneal dialysis patients: a randomized controlled study[J]. Medicine, 2016, 95(13): e2991.
[8]	肖一凡. 基于真实世界的艾考糊精腹膜透析液疗效分析[D]. 沈阳: 中国医科大学, 2024.
	Xiao Y F. Analysis of the therapeutic effect of icodextrin peritoneal dialysate based on the real world[D]. Shenyang: China Medical University, 2024.
[9]	Morelle J, Sow A, Fustin C A, et al. Mechanisms of crystalloid versus colloid osmosis across the peritoneal membrane[J]. J Am Soc Nephrol, 2018, 29(7): 1875-1886.
[10]	Dousdampanis P, Musso C G, Trigka K. Icodextrin and peritoneal dialysis: advantages and new applications[J]. Int Urol Nephrol, 2018, 50(3): 495-500.
[11]	阳晓, 严骏飞, 余学清. 艾考糊精腹透液的临床优势及获益人群[J]. 中华肾脏病杂志, 2021, 37(6): 528-533.
	Yang X, Yan J F, Yu X Q. Clinical advantages of icodextrin peritoneal dialysis solution and its beneficial population[J]. Chinese Journal of Nephrology, 2021, 37(6): 528-533.
[12]	Wang I K, Lin C L, Yen T H, et al. Icodextrin reduces the risk of congestive heart failure in peritoneal dialysis patients[J]. Pharmacoepidemiol Drug Saf, 2018, 27(4): 447-452.
[13]	Paniagua R, Orihuela O, Ventura M J, et al. Echocardiographic, electrocardiographic and blood pressure changes induced by icodextrin solution in diabetic patients on peritoneal dialysis[J]. Kidney Int, 2008, 73: S125-S130.
[14]	Yoon H E, Chang Y K, Shin S J, et al. Benefits of a continuous ambulatory peritoneal dialysis (CAPD) technique with one icodextrin-containing and two biocompatible glucose-containing dialysates for preservation of residual renal function and biocompatibility in incident CAPD patients[J]. J Korean Med Sci, 2014, 29(9): 1217-1225.
[15]	Takatori Y, Akagi S, Sugiyama H, et al. Icodextrin increases technique survival rate in peritoneal dialysis patients with diabetic nephropathy by improving body fluid management: a randomized controlled trial[J]. Clin J Am Soc Nephrol, 2011, 6(6): 1337-1344.
[16]	Gokal R, Moberly J, Lindholm B, et al. Metabolic and laboratory effects of icodextrin[J]. Kidney Int, 2002, 62: S62-S71.
[17]	Kadiroğlu AK, Ustündag S, Kayabaşi H, et al. A comparative study of the effect of icodextrin based peritoneal dialysis and hemodialysis on lipid metabolism[J]. Indian J Nephrol, 2013, 23(5): 358.
[18]	Ng J K, Chan G C, Li P K. Icodextrin in peritoneal dialysis: implications on clinical practice and survival outcome[J]. Kidney360, 2022, 3(5): 793-795.
[19]	Kim Y L, van Biesen W. Fluid overload in peritoneal dialysis patients[J]. Semin Nephrol, 2017, 37(1): 43-53.
[20]	Davies S, Zhao J H, McCullough K P, et al. International icodextrin use and association with peritoneal membrane function, fluid removal, patient and technique survival[J]. Kidney360, 2022, 3(5): 872-882.
[21]	林爱武, 钱家麒, 李晓玫, 等. 腹膜转运特性明显影响艾考糊精腹透液的超滤量[J]. 中华肾脏病杂志, 2010, 26(7): 504-509.
	Lin A W, Qian J Q, Li X M, et al. Great influence of peritoneal transport characteristics on ultrafiltration of icodextrin[J]. Chinese Journal of Nephrology, 2010, 26(7): 504-509.
[22]	Lui S L, Yung S, Yim A, et al. A combination of biocompatible peritoneal dialysis solutions and residual renal function, peritoneal transport, and inflammation markers: a randomized clinical trial[J]. Am J Kidney Dis, 2012, 60(6): 966-975.
[23]	徐光, 任东升, 陶雅非, 等. 艾考糊精透析液治疗维持性腹膜透析容量超负荷患者疗效观察[J]. 中华实用诊断与治疗杂志, 2023, 37(6): 637-640.
	Xu G, Ren D S, Tao Y F, et al. Effect of icodextrin in maintenance peritoneal dialysis volume overload patients[J]. Journal of Chinese Practical Diagnosis and Therapy, 2023, 37(6): 637-640.
[24]	Sav T, Inanc M T, Dogan A, et al. Two daytime icodextrin exchanges decrease brain natriuretic peptide levels and improve cardiac functions in continuous ambulatory peritoneal dialysis patients[J]. Nephrology, 2010, 15(3): 307-312.
[25]	Paniagua R, Ventura M D J, Ávila-Díaz M, et al. Icodextrin improves metabolic and fluid management in high and high-average transport diabetic patients[J]. Perit Dial Int, 2009, 29(4): 422-432.
[26]	Cnossen T T, Konings C J, van der Sande F M, et al. Clinical effects of icodextrin in peritoneal dialysis[J]. NDT Plus, 2008, 1(suppl 4): iv18-iv22.
[27]	吴杏, 叶任高, 汪涛, 等. 尿毒症患者发生左心室肥厚的危险性及其相关因素[J]. 中国中西医结合肾病杂志, 2004, 5(1): 18-20.
	Wu X, Ye R G, Wang T, et al. Risk factors of left ventricular hypertrophy (LVH) and its relationship with blood volume of uremic patients[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2004, 5(1): 18-20.
[28]	Konings C J A M, Kooman J P, Schonck M, et al. Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: a randomized study[J]. Kidney Int, 2003, 63(4): 1556-1563.
[29]	鲍霞, 徐佳美, 黄春香, 等. 艾考糊精透析液在腹膜透析患者心力衰竭中的应用效果观察[J]. 中国中西医结合肾病杂志, 2025, 26(3): 234-236.
	Bao X, Xu J M, Huang C X, et al. Effect of icodextrin dialysate on heart failure in peritoneal dialysis patients[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2025, 26(3): 234-236.
[30]	Rodríguez-Carmona A, Fontán M P, López E G, et al. Use of icodextrin during nocturnal automated peritoneal dialysis allows sustained ultrafiltration while reducing the peritoneal glucose load: a randomized crossover study[J]. Perit Dial Int, 2007, 27(3): 260-266.
[31]	彭凯月, 韩庆烽. 基于艾考糊精透析液的腹膜透析治疗进展[J]. 中国血液净化, 2022, 21(8): 595-598.
	Peng K Y, Han Q F. Progress in peritoneal dialysis treatment based on icodextrin[J]. Chinese Journal of Blood Purification, 2022, 21(8): 595-598.
[32]	中华医学会肾脏病学分会, 中关村肾病血液净化创新联盟. 中国透析患者慢性心力衰竭管理指南[J]. 中华肾脏病杂志, 2022, 38(5): 465-496.
	Chinese Society of Nephrology, Zhongguancun Nephrology & Blood Purification Innovation Alliance. Guidelines for the management of chronic heart failure in dialysis patients in China[J]. Chinese Journal of Nephrology, 2022, 38(5): 465-496.
[33]	Woodrow G, Oldroyd B, Stables G, et al. Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis[J]. Nephrol Dial Transplant, 2000, 15(6): 862-866.
[34]	Rangaswamy D, Guddattu V, Webster A C, et al. Icodextrin use for peritoneal dialysis in Australia: a cohort study using Australia and New Zealand Dialysis and Transplant Registry[J]. Perit Dial Int, 2020, 40(2): 209-219.
[35]	Han S H, Ahn S V, Yun J Y, et al. Effects of icodextrin on patient survival and technique success in patients undergoing peritoneal dialysis[J]. Nephrol Dial Transplant, 2012, 27(5): 2044-2050.
[36]	Wang I K, Li Y F, Chen J H, et al. Icodextrin decreases technique failure and improves patient survival in peritoneal dialysis patients[J]. Nephrology, 2015, 20(3): 161-167.
[37]	Wang I K, Chan C I, Lin A H, et al. The impact of icodextrin on the outcomes of incident peritoneal dialysis patients[J]. PLoS One, 2024, 19(3): e0297688.

Item	Total (n=120)	ICO group (n=40)	Control group (n=80)	P value
Gender				0.899
Male/n(%)	62 (51.67)	21 (52.50)	41 (51.25)
Female/n(%)	58 (48.33)	19 (47.50)	39 (48.75)
Age/year	60.25±12.00	61.25±8.16	59.58±14.13	0.080
BMI/(kg·m^-2)	24.14±2.27	24.66±1.86	23.79±3.25	0.296
PD duration/month	16.5 (9.0, 22.0)	11.5 (9.0, 20.8)	17.0 (10.5, 23.8)	0.342
Smoking/n(%)	17 (14.17)	4 (10.00)	13 (16.25)	0.583
Comorbidity/n(%)
CVD	23 (19.17)	9 (22.50)	14 (17.50)	0.505
Hypertension	83 (69.17)	29 (72.50)	54 (67.50)	0.573
Diabetes	44 (36.67)	15 (37.50)	29 (36.25)	0.894
Cerebral infarction	7 (5.83)	2 (5.00)	5 (6.25)	0.782
Primary kidney disease/n(%)				0.260
Chronic glomerulonephritis	58 (48.33)	17 (42.50)	41 (51.25)
Diabetic nephropathy	39 (32.50)	13 (32.50)	26 (32.50)
Hypertensive nephropathy	17 (14.17)	6 (15.00)	11 (13.75)
Others	6 (5.00)	4 (10.00)	2 (2.50)
OH/L	4.35±0.95	4.31±0.95	4.38±0.97	0.809
SBP/mmHg	142.85±23.92	151.88±23.64	136.83±22.62	0.034
DBP/mmHg	80.23±12.67	83.25±15.22	78.21±10.51	0.036
Hb/(g·L^-1)	96.12±13.02	92.87±14.38	98.29±11.85	0.202
CRP/(mg·L^-1)	14.14±19.50	10.58±12.61	16.51±13.04	0.057
IL-6/(pg·mL^-1)	24.98±15.08	39.57±10.82	25.26±13.22	0.072
FBG/(mmol·L^-1)	6.45±2.23	6.63±3.05	6.32±1.52	0.712
HbA1c/%	6.32±1.59	6.68±2.17	6.08±1.04	0.323
Alb/(g·L^-1)	31.82±4.38	30.56±4.47	32.66±4.2	0.146
BUN/(μmol·L^-1)	23.40±5.98	22.40±6.04	24.37±6.10	0.587
TC/(mmol·L^-1)	4.73±1.49	4.76±1.38	4.70±1.59	0.914
TAG/(mmol·L^-1)	1.81±0.94	1.84±0.89	1.78±1.01	0.860
LDL-C/(mmol·L^-1)	2.46±1.06	2.42±1.13	2.48±1.03	0.526
HDL-C/(mmol·L^-1)	1.01±0.35	0.95±0.34	1.15±0.42	0.309
Ca/(mmol·L^-1)	2.21±0.30	2.06±0.27	2.32±0.28	0.871
P/(mmol·L^-1)	1.87±0.61	1.93±0.75	1.84±0.50	0.190
Ca×P/(mg²·dL^-2)	51.00±18.67	49.60±21.03	51.92±17.33	0.376
NT-proBNP/(pg·mL^-1)	7 900 (4 339, 14 025)	7 650 (4 425, 15 375)	8 050(4 189, 13 755)	0.740
PTH/(ng·L^-1)	188.50 (109.25, 305.52)	175.00 (118.07, 301.0)	201.15 (87.42, 362.52)	0.759
SI/(μmol·L^-1)	12.97±4.60	11.73±4.47	13.80±4.58	0.838
TIBC/(μmol·L^-1)	48.94±11.85	50.80±12.85	47.70±11.24	0.547
SF/(ng·mL^-1)	156.50 (67.12, 434.25)	169.00 (132.50, 417.50)	143.00 (48.65, 478.50)	0.438
24 h urine volume/mL	500 (50, 1 000)	550 (313, 1 075)	495 (0, 950)	0.351
24 h ultrafiltration volume/mL	696 (245, 973)	660 (401, 938)	710 (55, 995)	0.790
rGFR/[mL·(min·1.73 m²)^-1]	0.78±0.84	0.53±0.16	0.51±0.16	0.829
r-Kt/V	0.40±0.28	0.43±0.26	0.38±0.29	0.513
p-Kt/V	1.26±0.49	1.14±0.51	1.35±0.47	0.211
t-Kt/V	1.65±0.40	1.55±0.46	1.73±0.34	0.199
nPCR/(g·kg^-1·d^-1)	0.45±0.08	0.41±0.06	0.48±0.08	0.178
Peritoneal transport type/n(%)				0.874
High transport	42 (35.00)	14 (35.00)	28 (35.00)
High average	51 (42.50)	18 (45.00)	33 (41.30)
Low average	21 (17.50)	6 (15.00)	15 (18.70)
Low transport	6 (5.00)	2 (5.00)	4 (5.00)
Baseline medication/n(%)
RAS inhibitor	85 (70.80)	29 (72.50)	56 (70.00)	0.772
β-blocker	58 (48.30)	18 (45.00)	40 (50.00)	0.602
Calcium channel blocker	71 (59.20)	25 (62.50)	46 (57.50)	0.598
Diuretic	45 (37.50)	14 (35.00)	31 (38.80)	0.692
Antiplatelet agent	38 (31.70)	11 (27.50)	27 (33.80)	0.485
Statin	52 (43.30)	16 (40.00)	36 (45.00)	0.601
Insulin	30 (25.00)	9 (22.50)	21 (26.30)	0.654

Item	Total (n=120)	ICO group (n=40)	Control group (n=80)	P value
Gender				0.899
Male/n(%)	62 (51.67)	21 (52.50)	41 (51.25)
Female/n(%)	58 (48.33)	19 (47.50)	39 (48.75)
Age/year	60.25±12.00	61.25±8.16	59.58±14.13	0.080
BMI/(kg·m^-2)	24.14±2.27	24.66±1.86	23.79±3.25	0.296
PD duration/month	16.5 (9.0, 22.0)	11.5 (9.0, 20.8)	17.0 (10.5, 23.8)	0.342
Smoking/n(%)	17 (14.17)	4 (10.00)	13 (16.25)	0.583
Comorbidity/n(%)
CVD	23 (19.17)	9 (22.50)	14 (17.50)	0.505
Hypertension	83 (69.17)	29 (72.50)	54 (67.50)	0.573
Diabetes	44 (36.67)	15 (37.50)	29 (36.25)	0.894
Cerebral infarction	7 (5.83)	2 (5.00)	5 (6.25)	0.782
Primary kidney disease/n(%)				0.260
Chronic glomerulonephritis	58 (48.33)	17 (42.50)	41 (51.25)
Diabetic nephropathy	39 (32.50)	13 (32.50)	26 (32.50)
Hypertensive nephropathy	17 (14.17)	6 (15.00)	11 (13.75)
Others	6 (5.00)	4 (10.00)	2 (2.50)
OH/L	4.35±0.95	4.31±0.95	4.38±0.97	0.809
SBP/mmHg	142.85±23.92	151.88±23.64	136.83±22.62	0.034
DBP/mmHg	80.23±12.67	83.25±15.22	78.21±10.51	0.036
Hb/(g·L^-1)	96.12±13.02	92.87±14.38	98.29±11.85	0.202
CRP/(mg·L^-1)	14.14±19.50	10.58±12.61	16.51±13.04	0.057
IL-6/(pg·mL^-1)	24.98±15.08	39.57±10.82	25.26±13.22	0.072
FBG/(mmol·L^-1)	6.45±2.23	6.63±3.05	6.32±1.52	0.712
HbA1c/%	6.32±1.59	6.68±2.17	6.08±1.04	0.323
Alb/(g·L^-1)	31.82±4.38	30.56±4.47	32.66±4.2	0.146
BUN/(μmol·L^-1)	23.40±5.98	22.40±6.04	24.37±6.10	0.587
TC/(mmol·L^-1)	4.73±1.49	4.76±1.38	4.70±1.59	0.914
TAG/(mmol·L^-1)	1.81±0.94	1.84±0.89	1.78±1.01	0.860
LDL-C/(mmol·L^-1)	2.46±1.06	2.42±1.13	2.48±1.03	0.526
HDL-C/(mmol·L^-1)	1.01±0.35	0.95±0.34	1.15±0.42	0.309
Ca/(mmol·L^-1)	2.21±0.30	2.06±0.27	2.32±0.28	0.871
P/(mmol·L^-1)	1.87±0.61	1.93±0.75	1.84±0.50	0.190
Ca×P/(mg²·dL^-2)	51.00±18.67	49.60±21.03	51.92±17.33	0.376
NT-proBNP/(pg·mL^-1)	7 900 (4 339, 14 025)	7 650 (4 425, 15 375)	8 050(4 189, 13 755)	0.740
PTH/(ng·L^-1)	188.50 (109.25, 305.52)	175.00 (118.07, 301.0)	201.15 (87.42, 362.52)	0.759
SI/(μmol·L^-1)	12.97±4.60	11.73±4.47	13.80±4.58	0.838
TIBC/(μmol·L^-1)	48.94±11.85	50.80±12.85	47.70±11.24	0.547
SF/(ng·mL^-1)	156.50 (67.12, 434.25)	169.00 (132.50, 417.50)	143.00 (48.65, 478.50)	0.438
24 h urine volume/mL	500 (50, 1 000)	550 (313, 1 075)	495 (0, 950)	0.351
24 h ultrafiltration volume/mL	696 (245, 973)	660 (401, 938)	710 (55, 995)	0.790
rGFR/[mL·(min·1.73 m²)^-1]	0.78±0.84	0.53±0.16	0.51±0.16	0.829
r-Kt/V	0.40±0.28	0.43±0.26	0.38±0.29	0.513
p-Kt/V	1.26±0.49	1.14±0.51	1.35±0.47	0.211
t-Kt/V	1.65±0.40	1.55±0.46	1.73±0.34	0.199
nPCR/(g·kg^-1·d^-1)	0.45±0.08	0.41±0.06	0.48±0.08	0.178
Peritoneal transport type/n(%)				0.874
High transport	42 (35.00)	14 (35.00)	28 (35.00)
High average	51 (42.50)	18 (45.00)	33 (41.30)
Low average	21 (17.50)	6 (15.00)	15 (18.70)
Low transport	6 (5.00)	2 (5.00)	4 (5.00)
Baseline medication/n(%)
RAS inhibitor	85 (70.80)	29 (72.50)	56 (70.00)	0.772
β-blocker	58 (48.30)	18 (45.00)	40 (50.00)	0.602
Calcium channel blocker	71 (59.20)	25 (62.50)	46 (57.50)	0.598
Diuretic	45 (37.50)	14 (35.00)	31 (38.80)	0.692
Antiplatelet agent	38 (31.70)	11 (27.50)	27 (33.80)	0.485
Statin	52 (43.30)	16 (40.00)	36 (45.00)	0.601
Insulin	30 (25.00)	9 (22.50)	21 (26.30)	0.654

Item	Follow-up time	ICO group^①	Control group^②	P value
PASP/mmHg	Baseline	34.65±6.87	32.55±4.40	0.099
PASP/mmHg	12-month	34.50±5.95	32.98±3.24	0.168
LVEDd/mm	Baseline	51.38±4.02	50.96±4.07	0.758
LVEDd/mm	12-month	48.94±2.98^③	51.38±4.35	0.045
LVESd/mm	Baseline	33.00±7.48	33.60±6.12	0.683
LVESd/mm	12-month	34.10±5.46	34.05±5.41	0.968
IVS/mm	Baseline	10.50±1.55	10.38±1.58	0.810
IVS/mm	12-month	10.81±1.05	10.50±1.14	0.369
ARD/mmHg	Baseline	32.06±2.46	31.00±2.23	0.155
ARD/mmHg	12-month	31.56±1.71	31.71±2.00	0.796
LAD/mm	Baseline	39.38±3.40	38.63±3.07	0.470
LAD/mm	12-month	38.63±2.47	39.00±2.45	0.647
LVEF/%	Baseline	57.30±4.50	59.30±1.50	0.095
LVEF/%	12-month	60.00±4.50^④	57.50±2.50^⑤	0.045
LVMI/(g·m^-2)	Baseline	117.19±10.52	114.29±10.30	0.401
LVMI/(g·m^-2)	12-month	107.69±8.47^⑥	111.71±8.51	0.038

Item	Follow-up time	ICO group^①	Control group^②	P value
PASP/mmHg	Baseline	34.65±6.87	32.55±4.40	0.099
PASP/mmHg	12-month	34.50±5.95	32.98±3.24	0.168
LVEDd/mm	Baseline	51.38±4.02	50.96±4.07	0.758
LVEDd/mm	12-month	48.94±2.98^③	51.38±4.35	0.045
LVESd/mm	Baseline	33.00±7.48	33.60±6.12	0.683
LVESd/mm	12-month	34.10±5.46	34.05±5.41	0.968
IVS/mm	Baseline	10.50±1.55	10.38±1.58	0.810
IVS/mm	12-month	10.81±1.05	10.50±1.14	0.369
ARD/mmHg	Baseline	32.06±2.46	31.00±2.23	0.155
ARD/mmHg	12-month	31.56±1.71	31.71±2.00	0.796
LAD/mm	Baseline	39.38±3.40	38.63±3.07	0.470
LAD/mm	12-month	38.63±2.47	39.00±2.45	0.647
LVEF/%	Baseline	57.30±4.50	59.30±1.50	0.095
LVEF/%	12-month	60.00±4.50^④	57.50±2.50^⑤	0.045
LVMI/(g·m^-2)	Baseline	117.19±10.52	114.29±10.30	0.401
LVMI/(g·m^-2)	12-month	107.69±8.47^⑥	111.71±8.51	0.038

Factor	Univariate analysis			Multivariate analysis
Factor	HR	95%CI	P value	HR	95%CI	P value
Age (per year increase)	2.50	1.38‒3.30	0.028	2.4	1.48‒3.40	0.112
PD duration (per month increase)	3.81	2.90‒4.80	0.898
Diabetes (Yes vs No)	1.32	1.27‒2.80	0.039	1.23	0.98‒3.44	0.078
Concomitant CVD (Yes vs No)	0.41	0.17‒0.89	0.029	1.57	1.07‒2.33	0.035
Use of ICO (Yes vs No)	0.41	0.28‒0.80	0.015	0.35	0.17‒0.89	0.012
High peritoneal transport (Yes vs No)	1.92	1.15‒3.45	0.021	1.65	1.08‒2.89	0.045
OH (per 0.1 L increase)	2.53	1.80‒3.40	0.104
HbA1c (per 1% increase)	0.72	0.39‒0.94	0.109
Alb (per 1 g·L^-1 decrease)	0.81	0.64‒1.15	0.541
NT-proBNP (per 100 pg·mL^-1 increase)	1.42	1.02‒2.50	0.024	1.38	1.13‒2.89	0.013
CRP (per 1 mg·L^-1 increase)	1.15	1.05‒1.26	0.003	1.10	1.01‒1.20	0.054
t-Kt/V (per 0.1 decrease)	0.83	0.33‒0.97	0.023	0.99	0.29‒1.02	0.088
r-Kt/V (per 0.1 decrease)	1.25	1.08‒1.45	0.003	1.15	0.98‒1.34	0.089
Use of RAS inhibitor (Yes vs No)	0.55	0.31‒0.98	0.042	0.61	0.34‒1.09	0.095