Spurious hyperglycaemia and icodextrin in peritoneal dialysis fluidBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7415.608 (Published 11 September 2003) Cite this as: BMJ 2003;327:608
All rapid responses
The case report by Riley et al again highlights the potential danger
of undiagnosed hypoglycaemia or “pseudohyperglycaemia” in a subset of
diabetic patients with end-stage renal disease using Icodextrin for
dialysis. Until now, these life-threatening events have been limited to
those patients in whom glucose dehydrogenase-based glucose monitoring
meters have been used for continuous blood glucose monitoring on the
As well as reporting similar events with median (IQR) differences of
up to 4.8 (4.2-5.7) mmol/1, we have also demonstrated that the lower the
true laboratory blood glucose value the greater the percentage deviation
of the corresponding capillary blood glucose value obtained by using the
glucose dehydrogenase-based meters. This “pseudohyperglycaemia” found in
some cases is extremely dangerous because of the risk of undiagnosed and
usually very severe hypoglycaemia in diabetic patients using insulin for
strict glycaemic control.
There have been reports concerning the interaction between Icodextrin
and blood glucose monitoring. Additionally, the literature supplied with
these meters do mention potential interactions. However, as Riley et al
have pointed out, both the diabetic and renal teams seem to be unaware of
this potentially life-threatening problem.
In the light of these events the blood glucose monitoring meters in
question have been withdrawn from our renal wards and a notice “not to be
used in patients receiving Icodextrin for CAPD” has been put on these
It is important not to assume that all other meters that do not use
the glucose dehydrogenase enzymatic method are safe for use in all such
patients. The manufacturers of these meters need to highlight this
potential problem: change this warning from “small print” to “very large
print”. Additionally, before using any glucose analyser for monitoring
capillary blood glucose levels in diabetic-renal patients, the analyser
should be cross-checked with the laboratory reference method.
1. Riley SG, Chess J, Donovan KL, Williams JD. Spurious hyperglycaemia and
icodextrin in peritoneal fluid. BMJ 2003; 327: 608-9. (13 September.)
2. Oyibo SO, Pritchard GM, Mclay L, James E, Laing I, Gokal R, et al.
Blood glucose overestimation in diabetic patients on continuous ambulatory
peritoneal dialysis for end-stage renal disease. Diabet Med 2002; 19: 693-
3. Wen R, Taminne M, Devriendt J, Collart F, Broeders N, Mestrez F, et al.
A previously undescribed side effect of icodextrin: overestimation of
glycaemia by glucose analyser. Perit Dial Int 1998; 18: 603-9.
4. Janssen W, Harff G, Caers M, Schellekens A. Positive interference of
icodextrin metabolites in some enzymatic glucose methods. Clin Chem 1998;
Competing interests: No competing interests