Intradialytic Parenteral Nutrition
Article Sidebar
Main Article Content
Abstract
Patients with end-stage kidney disease undergoing hemodialysis are at an increased risk of morbidity and mortality, which is closely associated with altered nutritional status and the development of protein-energy wasting. Although nutritional counseling and oral nutritional supplements are primary interventions, they may not always be sufficient to improve nutritional status. As a result, intradialytic parenteral nutrition (IDPN) has emerged as a promising alternative to support nutritional needs. Although studies indicate that IDPN can improve nutritional parameters—such as serum protein levels, body weight, and overall quality of life—robust evidence on clinical outcomes, such as hospitalization or mortality, remains limited. This article aims to review the literature on IDPN, including indications for use, outcomes, IDPN composition, and assessment of clinical response, to enhance utilization and develop effective clinical recommendations to optimize nutritional support for hemodialysis patients.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This article is published under CC BY-NC-ND 4.0 license, which allows for non-commercial reuse of the published paper as long as the published paper is fully attributed. Anyone can share (copy and redistribute) the material in any medium or format without having to ask permission from the author or the Nephrology Society of Thailand.
References
Martinson M, Ikizler TA, Morrell G, Wei G, Almeida N, Marcus RL, et al. Associations of body size and body composition with functional ability and quality of life in hemodialysis patients. Clin J Am Soc Nephrol 2014;9(6):1082-90. doi: 10.2215/CJN.09200913.
Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, et al. Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis 2009;53(2):298-309. doi: 10.1053/j.ajkd.2008.09.018.
Stenvinkel P. Inflammation in end-stage renal disease--a fire that burns within. Contrib Nephrol 2005;149:185-99. doi: 10.1159/000085525.
Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008;73(4):391-8. doi: 10.1038/sj.ki.5002585.
Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, et al. Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism. J Ren Nutr 2018;28(6):380-92. doi: 10.1053/j.jrn.2018.08.006.
Lopes AA, Bragg-Gresham JL, Elder SJ, Ginsberg N, Goodkin DA, Pifer T, et al. Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Ren Nutr 2010;20(4):224-34. doi: 10.1053/j.jrn.2009.10.002.
Dong J, Li Y, Xu Y, Xu R. Daily protein intake and survival in patients on peritoneal dialysis. Nephrol Dial Transplant 2011;26(11):3715-21. doi: 10.1093/ndt/gfr142.
Amparo FC, Cordeiro AC, Carrero JJ, Cuppari L, Lindholm B, Amodeo C, et al. Malnutrition-inflammation score is associated with handgrip strength in nondialysis-dependent chronic kidney disease patients. J Ren Nutr 2013;23(4):283-7. doi: 10.1053/j.jrn.2012.08.004.
Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis 2020;76(3 Suppl 1):S1-S107. doi: 10.1053/j.ajkd.2020.05.006.
Carrero JJ, Severs D, Aguilera D, Fiaccadori E, Gonzalez MG, Haufe CC, et al. Intradialytic parenteral nutrition for patients on hemodialysis: when, how and to whom? Clin Kidney J 2023;16(1):5-18. doi: 10.1093/ckj/sfac171.
Pupim LB, Flakoll PJ, Brouillette JR, Levenhagen DK, Hakim RM, Ikizler TA. Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients. J Clin Invest 2002;110(4):483-92. doi: 10.1172/JCI15449.
Fuller MF, Crofts RM. The protein-sparing effect of carbohydrate. 1. Nitrogen retention of growing pigs in relation to diet. Br J Nutr 1977;38(3):479-88. doi: 10.1079/bjn19770113.
Wongdama S, Lertsiripatarajit P, Wongdama S, Virojanapa K, Chuthapisith S, Siriussawakul A, et al. Performance of a simplified nutrition screening tool for outpatient radiotherapy cancer patients. Medicine (Baltimore) 2023;102(19):e33778. doi: 10.1097/MD.0000000000033778.
Sabatino A, Regolisti G, Antonucci E, Cabassi A, Morabito S, Fiaccadori E. Intradialytic parenteral nutrition in end-stage renal disease: practical aspects, indications and limits. J Nephrol 2014;27(4):377-83. doi: 10.1007/s40620-014-0051-6.
Garcia de Lorenzo A, Arrieta J, Ayucar A, Barril G, Huarte E, Sociedad Espanola de N, et al. [Intra-dialysis parenteral nutrition in chronic renal patients: consensus SEN-SENPE]. Nutr Hosp 2010;25(3):375-7.
Guarnieri G, Faccini L, Lipartiti T, Ranieri F, Spangaro F, Giuntini D, et al. Simple methods for nutritional assessment in hemodialyzed patients. Am J Clin Nutr 1980;33(7):1598-607. doi: 10.1093/ajcn/33.7.1598.
Cano N, Labastie-Coeyrehourq J, Lacombe P, Stroumza P, di Costanzo-Dufetel J, Durbec JP, et al. Perdialytic parenteral nutrition with lipids and amino acids in malnourished hemodialysis patients. Am J Clin Nutr 1990;52(4):726-30. doi: 10.1093/ajcn/52.4.726.
Cano NJ, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, et al. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol 2007;18(9):2583-91. doi: 10.1681/ASN.2007020184.
Thabet AF, Moeen SM, Labiqe MO, Saleh MA. Could intradialytic nutrition improve refractory anaemia in patients undergoing haemodialysis? J Ren Care 2017;43(3):183-91. doi: 10.1111/jorc.12206.
Cano NJ, Saingra Y, Dupuy AM, Lorec-Penet AM, Portugal H, Lairon D, et al. Intradialytic parenteral nutrition: comparison of olive oil versus soybean oil-based lipid emulsions. Br J Nutr 2006;95(1):152-9. doi: 10.1079/bjn20051595.
Navarro JF, Mora C, Leon C, Martin-Del Rio R, Macia ML, Gallego E, et al. Amino acid losses during hemodialysis with polyacrylonitrile membranes: effect of intradialytic amino acid supplementation on plasma amino acid concentrations and nutritional variables in nondiabetic patients. Am J Clin Nutr 2000;71(3):765-73. doi: 10.1093/ajcn/71.3.765.
Liu Y, Xiao X, Qin DP, Tan RS, Zhong XS, Zhou DY, et al. Comparison of Intradialytic Parenteral Nutrition with Glucose or Amino Acid Mixtures in Maintenance Hemodialysis Patients. Nutrients 2016;8(6). doi: 10.3390/nu8060220.
Marsen TA, Beer J, Mann H, German I-Tg. Intradialytic parenteral nutrition in maintenance hemodialysis patients suffering from protein-energy wasting. Results of a multicenter, open, prospective, randomized trial. Clin Nutr 2017;36(1):107-17. doi: 10.1016/j.clnu.2015.11.016.
Lacson E, Jr., Wang W, DeVries C, Leste K, Hakim RM, Lazarus M, et al. Effects of a nationwide predialysis educational program on modality choice, vascular access, and patient outcomes. Am J Kidney Dis 2011;58(2):235-42. doi: 10.1053/j.ajkd.2011.04.015.
Kittiskulnam P, Banjongjit A, Metta K, Tiranathanagul K, Avihingsanon Y, Praditpornsilpa K, et al. The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial. Sci Rep 2022;12(1):4529. doi: 10.1038/s41598-022-08726-8.
