Objective To investigate the clinical efficacy of icodextrin dialysate in peritoneal dialysis for patients with diabetic nephropathy.Methods A case-control study was conducted to retrospectively analyze 92 patients with diabetic nephropathy who underwent peritoneal dialysis at Yiwu Central Hospital from January 2021 to December 2023.The patients were divided into two groups based on the type of dialysis solution used:the control group(n=45)received glucose-based dialysate,while the observation group(n=47)received icodextrin dialysate.Both groups underwent dialysis for 2 months.Glycemic control indicators,lipid profiles,adverse reactions,and volume overload parameters(diastolic pressure,systolic pressure,and ultrafiltration volume)were assessed in both groups.Results After treatment,fasting blood glucose,glycated hemoglobin,2-hour postprandial blood glucose,triglycerides,and low-density lipoprotein cholesterol levels in the observation group were(7.56±0.97)mmol/L,(7.64±1.55)%,(8.49±1.42)mmol/L,(2.02±0.39)mmol/L,and(3.10±0.47)mmol/L,respectively,all of which were significantly lower than those in the control group[(8.27±1.25)mmol/L,(8.77±1.89)%,(9.39±1.64)mmol/L,(2.30±0.44)mmol/L,(3.46±0.55)mmol/L,t=3.05,3.14,2.82,3.23,3.38,all P<0.05].The incidence of adverse reactions in the observation group was significantly lower than that in the control group[12.77%(6/47)vs.31.11%(14/45),x2=4.55,P<0.05].After treatment,the diastolic pressure and systolic pressure in the observation group were(83.75±8.55)mmHg(1 mmHg=0.133 kPa)and(142.35±15.78)mmHg,respectively,both of which were significantly lower than those in the control group[(88.79±8.90)mmHg,(156.20±16.19)mmHg,t=2.77,4.16,both P<0.05].However,the ultrafiltration volume in the observation group was signifiantly higher than that in the control group[(638.77±64.21)mL vs.(590.41±60.34)mL,t=3.72,P<0.05].Conclusion Peritoneal dialysis using icodextrin dialysate in patients with diabetic nephropathy can improve glucose and lipid metabolism,reduce the incidence of adverse reactions,and effectively manage patients'volume overload.