Intradialytic Parenteral Nutrition Research Articles

Nutrizione parenterale intradialitica in pazienti con malnutrizione moderata-severa: studio prospettico osservazionale multicentrico

Dialysis patients have a wide range of pathologies that contribute to their frailty. Maintaining a good nutritional status is useful to prevent and treat the so-called Protein-Energy Wasting (PEW), a complex clinical-laboratory condition in which a protein-energy depletion occurs. Adherence to a proper nutritional therapy in CKD requires considerable effort from both patients and health personnel (doctors and nurses). In order to slow down the effects of malnutrition and the disasters that complicate PEW, nephrologists can use supplementation products. In our observational, prospective, multicentre study, we administered an intradialytic parenteral nutrition of a three-compartment emulsion for intravenous infusion through an infusion pump connected to the venous line. After 12 weeks of treatment, subjects with severe malnutrition were reduced from 61.1% to 33.3%, serum creatinine increased by 16% (from 6.00 ± 1.48 mg/dL to 6.98 ± 2.46 mg/dL; P < 0.001), total protein and albumin levels respectively by 13% (from 5.46 ± 0.63 g/dL to 6.19 ± 0.66 g/dL; P < 0.001) and 19% (from 2.70 ± 0.48 g/dL to 3.20 ± 0.57 g/dL; P < 0.001), body weight by 3% (from 55.7 ± 13.2 kg to 57.6 ± 13.0 kg; P < 0.001).

Effect of nutritional support on nutritional status and inflammation in malnourished patients undergoing maintenance hemodialysis.

Protein energy wasting/malnutrition is a strong predictor of morbidity and mortality in patients on maintenance hemodialysis (MHD). We aimed to compare the effects of oral and/or intradialytic parenteral nutrition (IDPN) support on nutritional and inflammatory parameters in malnourished patients with MHD. This is an observational study of 56 malnourished patients on MHD. We offered combined oral nutritional support (ONS) and IDPN for 12 months to all patients. Depending on patient choices for treatment, they were classified into four groups: group 1 (ONS only), group 2 (IDPN only), group 3 (both ONS and IDPN), and group 4 (patients who refused artificial nutrition support and only followed dietary advice). Normalized protein catabolic rate (nPCR), malnutrition inflammation score (MIS), and body composition (fat mass [FM], muscle mass [MM]) were assessed monthly. The mean serum albumin levels of groups 2 and 3 significantly increased with the intervention, whereas that of group 4 significantly decreased. The mean nPCR levels of groups 2 and 3 significantly increased. Group 3 had the most significant positive change in serum albumin and nPCR levels. Mean serum C-reactive protein (CRP) levels of groups 1, 2, and 3 decreased, whereas those of group 4 increased. A ∆ in CRP was only identified in group 3. The MIS of groups 1, 2, and 3 significantly decreased whereas that of group 4 significantly increased. The ∆% in FM was 1.1, 1.9, 9.1, and -2.9 for groups 1, 2, 3, and 4, respectively, and that in MM was -0.6, 4.4, 6.9, and -7.9 for groups 1, 2, 3, and 4, respectively. Compared to monotherapy or nutritional counseling, the choice of ONS plus IDPN is associated with improved nutritional status and decreased inflammation in malnourished patients on MHD. Nonetheless, interventional studies must be conducted to confirm these observations.

Chronic Kidney Disease and Nutrition Support.

Individuals with chronic kidney disease (CKD), particularly those undergoing maintenance dialysis, are prone to protein-energy wasting (PEW), the latter of which can be ameliorated with different methods of nutrition support. Dietary counseling guided by dietitians is the key for preventing and managing PEW in CKD. If dietary counseling per se fails to meet the recommended energy and protein requirements, the addition of oral nutrition supplements (ONSs) would be necessary. When these initial measures cannot attain the recommended energy and protein requirements, nutrition support, including enteral tube feeding or parenteral nutrition (PN), should be considered as a viable option to improve nutrition status. Partial PN, comprising intraperitoneal PN (IPPN) and intradialytic PN (IDPN) therapies, may be attempted as supplemental nutrition support in patients with PEW requiring peritoneal dialysis and hemodialysis, respectively. Despite the debatable effectiveness of IPPN for patients undergoing peritoneal dialysis, it remains a feasible means in these patients. The indications for IPPN in patients undergoing peritoneal dialysis include inadequate dietary intake of energy and protein, and barriers of oral intake and other forms of enteral supplementation such as issues with suitability, tolerance, and compliance. Nonetheless, in the case of spontaneous dietary consumption of energy and protein meeting the difference between the IDPN provision and the nutrition targets, the use of IDPN is rational. In patients with PEW and malfunctioning gastrointestinal tract, as well as those whose enteral intake (with or without partial PN) is below the recommended nutrient requirements, total PN becomes a relevant nutrition intervention.

Efficacy of intradialytic amino acids on nutritional status in children with stage 5 chronic kidney disease

Protein energy wasting (PEW) is a common cause of morbidity and mortality in patients with stage 5 chronic kidney disease (CKD 5). Intradialytic parenteral nutrition (IDPN) has been used as a therapy for preventing and treating PEW in children with CKD 5 when other conventional modalities fail. However, not enough data is available to define its effectiveness in treating malnutrition in children. This study aims to investigate potential benefits of IDPN in Egyptian children with CKD 5. In this prospective, placebo-controlled, parallel-group single blinded study, we enrolled 50 CKD 5 patients; 25 patients (intervention group) received intravenous amino acids (KIDIMN), while 25 patients (control group) received normal saline as placebo, each given during regular dialysis 3 times a week for 9months. Patients were subjected to nutritional assessment at baseline and 3-, 6-, and 9-month follow-up using height Z-score, hand grip strength (HGS) for muscle power assessment, body composition monitor (BCM) for assessing lean tissue mass (LTM) and adipose tissue mass (ATM), and biochemical measures including serum albumin, serum triglyceride, and serum cholesterol. When comparing baseline and 9-month follow-up values, significant improvement was recorded in height Z-score, LTM, and serum albumin in the intervention group unlike the control group where no significant changes were recorded. IDPN is proposed to be an effective method for preventing and treating malnutrition in children with CKD 5. However, further multi-centric studies with larger sample size and longer duration of follow-up are still recommended.

Suspected hypersensitivity to Intradialytic parenteral nutrition: Results of the implementation of the Naranjo Algorithm

Rationale: Adverse reactions to the administration of parenteral nutrition are widely described; however, there is little literature available on hypersensitivity reactions during intradialytic administration. We present 4 hemodialysis patients who received intradialytic parenteral nutrition who developed adverse reactions to an unknown component of the formula.

SO047HEMODIAFILTRATION DECREASES RISE OF LEPTIN AND RESISTIN IN PROTEIN ENERGY WASTING (PEW) WITHOUT HARMFULL EFFECT ON ALBUMIN CONCENTRATION

Abstract Background and Aims The role of adipocytokines (ADCK), and particularly of anorectic leptin and of resistin in the mortality of PEW is strongly suspected. Convective techniques (ol-HDF) decrease leptin concentrations but induce a concomitant albumin loss which could be potentially harmful in malnourished patients. The aim of the prospective multicentric randomized study performed in France by the NUTRIPEPA GROUP is to compare one year evolution of 4 ADCK and seric albumin using HDF or HD and membranes with different cut-off. Method 47 patients responding to both criteria of albumin <35 g/l (mean of 3 dosages) and prognostic inflammatory and nutritional index (PINI)≥ 1 were randomized to be treated using either polyester polyarylate (PEPA Nikkiso Japan) or polysufone, polyethersulfone dialyser (control) and followed for one year. Treatment consists in 3*4 hours HD session or in 3 HDF sessions with more than 20 liters reinjection/session. 24 patients were treated with HDF (HDF gr) : 11 with PEPA, 13 with control, and 23 with HD (HD gr) : 13 with PEPA, 10 with control. Oral nutritional supplementation was systematic, eventually completed by intradialytic parenteral nutrition. Albumin, leptin, adiponectin, ghrelin and resistin concentrations were determined at M0, M6, M9, M12. Delta concentration M0-M12 of albumin and of the 4 ADCK were compared with Wilcoxon test. Results At 12 months, decrease of leptin and of resistin was significantly higher in HDF group compare to HD group. There was no significant variation of adiponectin, ghrelin and albumin concentrations regardless of the technic or of dialyser cut-off. Conclusion In PEW, on a one year practice and regardless of the cut-off of the dialyser, HDF decreases both the anorexigenic adipokine leptin and resistin, adipokine implicated in insulin resistance, without harmfull incidence on seric albumin concentration. The decrease of concentrations of leptin and resistin obtained using ol-HDF could explain, at least in part, the reduction of one year mortality that we reported last year in preliminary results of NUTRIPEPA study.

Effects of intradialytic parenteral nutrition on antioxidant capacity in hemodialysis patients aged over 60 years

Objective: The aim of the present study was to investigate whether intradialytic parenteral nutrition can affect the antioxidant capacity of hemodialysis patients aged over 60 years. Methods: The study comprised 20 participants from the Baskent University Umitkoy Dialysis Center; 10 who had intradialytic parenteral nutrition [IDPN, study group (SG)] that included 500 cc of amino acid solution and 500 cc of dextrose were compared with the group that did not have IDPN for 1 month. The randomly selected group had IDPN. Serum albumin, prealbumin, cholesterol, blood urea nitrogen (BUN), creatinine, potassium, and phosphorus; weight; body mass index (BMI); hand muscle strength (HMS); and middle upper arm circumference (MUAC) were measured and compared at baseline and at the end of the study between two groups. After 4 weeks of treatment, thiobarbituric acid reactive substances (TBARS), glutathione peroxidase (GSH-Px), total antioxidant capacity (TAC), and tumor necrosis factor-alpha (TNF-α) values of two groups were compared. Results: There was no statistically significant difference between the baseline and outcome values of both groups in weight, BMI, HMS, MUAC, BUN, creatinine, potassium, albumin, and cholesterol values during the 1 month period. The SG had 19.97±7.18 kcal/kg/day energy and 0.77±0.21 g/kg/day protein intake. The control group (CG) had 18.66±3.22 kcal/kg/day energy and 0.64±0.11 g/kg/day protein intake. TBARS were 1.84±0.10 μM in the SG and 1.95±0.11 μM in the CG (p=0.031). The mean of TAC was 334.34±23.20 mmol/L in the SG and 290.23±17.72 mmol/L in the CG (p=0.002). The mean of GSH-Px was 305.63±35.31 U/L in the SG and 244.80±17.66 U/L in the CG (p=0.001). The mean of TNF-α was 171.24±25.37 pg/mL in the SG and 193.85±11.82 in the CG (p=0.017). Conclusion: Results suggest that energy and protein intake were very low in both groups. TBARS and TNF-α were lower in the SG than in the CG. TAC and GSH-Px were higher in the SG than in the CG. IDPN can be used both to increase the protein and energy intake and antioxidant capacity for patients aged over 60 years.

The Effect of Intradialytic Parenteral Nutrition on Nutritional Status and Quality of Life in Hemodialysis Patients

The Effect of Intradialytic Parenteral Nutrition on Nutritional Status and Quality of Life in Hemodialysis Patients

Practice Patterns Relating to the Use of Intradialytic Parenteral Nutrition in Australian Renal Units: Results From a Survey of Renal Dietitians

The objective of this study is to document the patterns of usage regarding intradialytic parenteral nutrition (IDPN) within in-center hemodialysis units in Australia. This study used purposive non-probabilistic sampling to obtain details of the proportion of units using IDPN; formulations used; infusion rates; and barriers and enablers to usage. All participants were practicing renal dietitians in Australia. The participants were recruited from professional nephrology networks and completed a cross-sectional self-administered online survey. A total of 68 responses were received, representing 41% of dialysis units in Australia. Half did not use IDPN at all, and one-third (38.2%) used it regularly. The most common IDPN formulations used were triple phase bags (48.3%) and lipid-only infusions (22.6%). Variation in practice was seen regarding maximum infusion rates for some formulations. Costs for IDPN were borne by dialysis units (74%) or pharmacy (16%). Barriers to the use of IDPN included bureaucratic hurdles and misconceptions about IDPN as an effective form of nutrition support. The presence of a protocol, support from medical and other staff, and dietitian experience were enablers to the use IDPN. IDPN use in Australia is not uncommon. This survey extends the small evidence base about the practice of IDPN and identified some important variations in practice. Some barriers to IDPN use could be overcome with further training to support staff. Enablers to IDPN use include protocols with defined responsibilities and access to experienced clinicians.

Böbrek Hastalıklarında Klinik Nütrisyon Yaklaşımı

Kronik böbrek yetmezliği (KBY), glomerül filtrasyon hızının (GFH) böbrek işlevlerinde saptanabilir düzeyde değişikliklere neden olacak kadar kalıcı bir şekilde azaldığı durum olarak tanımlanabilir. Son dönem böbrek yetmezliği (SDBY), endojen böbrek işlevinin geri dönüşümsüz kaybı ile karakterize ve hayatı tehdit eden üremiden korunmak için hastaya devamlı olarak diyaliz veya transplantasyon gibi renal replasman tedavilerinin uygulandığı klinik tabloyu oluşturur. SDBY insidansı ve prevalansı tüm dünyada artmaktadır. Kronik böbrek yetmezliğine eşlik eden üremik sendrom iştah kaybıyla, azalmış oral besin alımıyla sonuçlanan gastrointestinal yan etkilerle, metabolik asidoz, üremik toksisite, protein katabolizmasının başlamasıyla ilişkilidir. Malnütrisyon SDBY olan hastalarda önemli bir sorundur. Protein enerji malnütrisyonunun varlığı SDBY’de artmış mortalite ve morbidite ile ilişkilidir. Malnütrisyon sık görüldüğü için, beslenme durumunun periyodik olarak değerlendirilmesi, erken tanı ve uygun tedavide diyaliz hastalarının rutin bakımının bir parçasıdır. Öncelikle tıbbi beslenme tedavisi bireysel olarak düzenlenmeli, oral yolla yeterli enerji ve besin ögesi alamayan hastalar ve beden kütle indeksi <20 kg/m2, 6 ayda %10’dan fazla ağırlık kaybı, serum albümin <3.5 g/dL ve serum prealbümin <30 mg/dL gibi düşük nütrisyonel parametreleriyle belirlenen beslenme yetersizliği olan hastalar için mutlak beslenme desteği verilmelidir. Hastalar hastalığına özel diyet ve/veya oral nütrisyonel destek ile günlük beslenme gereksinmesini karşılayamadığında önce tüple enteral beslenme önerilir. Enteral beslenme uygulanamıyor ise total parenteral beslenme veya hemodiyaliz anında intradiyalitik parenteral beslenme uygulanmalıdır. Bu derleme makalede, böbrek hastalıklarında beslenme destek tedavi yöntemlerine odaklanılacaktır.

MON-306 INTRA-DIALYTIC PARENTERAL NUTRITION; A CASE SERIES OF NUTRITIONAL OUTCOMES IN AN AUSTRALIAN HAEMODIALYSIS UNIT

Intra-Dialytic Parenteral Nutrition (IDPN) has been demonstrated in the literature to be a feasible mode of nutrition support; however it is not widely accepted for use in malnourished haemodialysis (HD) patients in Australia. The aim of this study was to examine the effectiveness of supplemental IDPN on nutritional and patient-reported outcomes of malnourished HD patients.

SUN-082 EFFECTS OF ORAL COLLAGEN PEPTIDES ON NUTRITIONAL STATUS OF PERITONEAL DIALYSIS PATIENTS

Protein energy malnutrition is common amongst end stage renal disease patients and it is associated with increased morbidity and mortality. It is more prevalent in peritoneal dialysis (PD) patients compared to hemodialysis (HD) patients. Dietetic counselling, oral supplementation, enteral feeding, and intradialytic parenteral nutrition are amongst the intervention employed to improve nutritional status of dialysis patients. The aim of our study is to evaluate the effect of oral collagen peptides on the nutritional status of PD patients.

SUN-315 CAN ADMINISTRATION OF CLINOLEIC 20% DURING HAEMODIALYSIS ASSIST IN WEIGHT STABILISATION AND WEIGHT GAIN IN MALNOURISHED PATIENTS?

Improvement in the nutritional status of malnourished End Stage Kidney Disease patients on haemodialysis can require intensive nutritional therapy to achieve weight gain. Successful nutritional rehabilitation requires increased intake of nutrients either enterally or parenterally. Intra-dialytic parenteral nutrition (IDPN) can be provided as adjunct therapy to patients who are unable to meet requirements for weight gain via the enteral route alone.

Prise en charge pratique de la dénutrition des patients hémodialysés en France : enquête nationale

Protein energy wasting (PEW) is frequent among hemodialysis patients. Published international recommendations in this field are sometimes difficult to implement in daily practices. We evaluated daily practices of PEW screening and treatment in French hemodialysis centers using an online computerized questionnaire sent by email (1 answer required per center). Eighty-six centers returned the questionnaire filled by a nephrologist (43%), nurse (14%) or dietician (43%). The mean number of patients per center was 112±64 patients. PEW screening was performed at least once/month in 56% of centers, once/3 months in 36%, and less frequently in 8%. PEW screening frequency and tools were in agreement with recommendations. Regarding treatment, dietitian interviews were proposed in 98% of units. Hundred percent of units prescribed home oral nutrition supplements (ONS), and 90% ONS during hemodialysis. Ninety-seven percent of centers practiced intradialytic parenteral nutrition, 34% enteral nutrition with feeding tube and 41% with gastrostomy. 14% of centers had no dietician or only on call. A dietician was present≤1 day per week in 44% of centers, 1 to 2.5 days per week in 27%, and>2.5 days per week in 15%. After adjustment for the number of patients, private practice units had significantly less time of presence of the dietician than nonprofit associations or public healthcare centers. In all, 36% of centers offered physical activity during hemodialysis sessions – cycling in almost all centers – and only 12.8% proposed physical activity programs apart from dialysis sessions. In summary, in majority of French hemodialysis centers, PEW screening was consistent with recommendations but the dietician time was insufficient to screen for PEW causes and elaborate a treatment program. Only one third of centers perform enteral nutrition, the most recommended artificial nutrition therapy. Nutritional treatment could be improved in hemodialysis centers in France.

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Background: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HD patients have not been reported. Objectives: To survey nutrition intake in Israeli HD patients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HD patients. Methods: A representative sample of 378 Israeli HD patients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: “minimal”: body mass index (BMI) > 23 kg/m² and serum albumin > 3.8 g/dL; “mild”: BMI < 23 kg/m² and albumin > 3.8 g/dL; “moderate”: BMI > 23 kg/m² and albumin < 3.8 g/dL; “severe”: BMI < 23 k/m² and serum albumin < 3.8 g/dL. Results: Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. Discussion: Elevated malnutrition risk is a frequent finding in HD patients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HD patients with high malnutrition risk. There is a need to expand the survey to community HD centers.

Amino acid kinetics in diabetic patients during hemodiafiltration performed under intradialytic parenteral amino acid nutrition: A preliminary study

Amino acid kinetics in diabetic patients during hemodiafiltration performed under intradialytic parenteral amino acid nutrition: A preliminary study

Intradialytic Parenteral Nutrition in Pediatrics.

Children with end-stage renal disease (ESRD) on hemodialysis are at increased risk for malnutrition. Aggressive nutrition intervention such as intradialytic parenteral nutrition (IDPN) should be considered to prevent further co-morbidities and mortality associated with malnutrition when other interventions fail. IDPN is a non-invasive method of providing nutrition to malnourished hemodialysis (HD) patients via the HD access throughout the HD treatment. Although the evidence on the long-term benefits of IDPN is scant in pediatrics, there is evidence that it improves metabolic parameters and nutritional status. In this paper, therapy with IDPN including indications, goals of therapy, and elements to monitor will be described. In addition, a practice guideline for prescribing IDPN is provided.

Intradialytic Parenteral Nutrition: A Method of Copper Replacement

Copper is essential trace metal which plays vital role in electron transport reactions, iron hemostasis, pigment formation, neurotransmitter production, connective tissue biosynthesis and antioxidant defense mechanisms. A 58-year-old Caucasian man with ESRD on intermittent hemodialysis, chronic diarrhea and malabsorption after gastric bypass surgery on Intradialytic parenteral nutrition (IDPN) was evaluated for anemia with sub optimal response to high doses of erythropoietin and pancytopenia suspicious of myelodysplastic syndrome. Investigations listed in Figure 1. Bone Marrow biopsy showed refractory cytopenias with multi-lineage dysplasia. Cytogenetics showed no definitive immunophenotypic evidence of high-grade hematopoietic neoplasia, lymphoproliferative disease or plasma cell dyscrasia. He was started on daily oral therapy with copper gluconate with no improvement in the hematological parameters. Copper chloride was added to IDPN with improvement of all hematological parameters and copper levels [figure 2]. On attempting to withdraw therapy, severe drop in copper and cell counts were noted and was corrected with resumption of IDPN with copper supplementation. Copper deficiency can present as anemia and leukopenia, thrombocytopenia. Typical bone marrow findings mimic myelodysplastic syndrome including left shift in granulocytic & erythroid maturation & presence of ringed sideroblasts/hemosiderin containing plasma cells. Neurologic manifestations include ataxia, myeloneuropathy and cognitive deficits. Unlike neurologic deficits, hematologic manifestations can be reversed with copper supplementation. The current adult recommended intake is 0.9mg/day. The American society for metabolic and Bariatric surgery clinical practice recommend treatment of mild to moderate deficiency with oral (3-8mg/dl) and IV copper (2-4mg/dl) for severe deficiency. Oral supplementation may fail in patients with gastric bypass as copper is absorbed in stomach and duodenum. IDPN is relatively safe and efficacious modality of nutritional support which allows the administration of nutrients through extracorporeal circuit during hemodialysis in these patients. Other causes of copper deficiency include Post gastric bypass surgery, Excessive zinc ingestion or overloading during hemodialysis, celiac disease, cystic fibrosis, IBD and Bacterial overgrowth.2453_A Figure 1. Initial Patient Laboratory Values2453_B Figure 2. Hematological changes during treatment with copper. WBC - White blood cell count, HB - Hemoglobin, IDPN - Intradialytic Parenteral Nutrition, Oral - Oral supplementation

A case of refeeding syndrome during intradialytic parenteral nutrition

BackgroundRefeeding syndrome is a potentially fatal electrolyte shift in patients with rapid feeding after low-calorie intake. Although the key to diagnosing refeeding syndrome is hypophosphatemia after feeding, renal dysfunction might hide refeeding hypophosphatemia, especially in maintenance hemodialysis patients. Intradialytic parenteral nutrition (IDPN) is a therapeutic approach used to treat malnourished patients with maintenance hemodialysis. No earlier report describes a study of refeeding syndrome complicated with IDPN.Case presentationWe present a case of a 77-year-old man undergoing maintenance hemodialysis for 17 years. While IDPN was administered after 10 days fasting, ventricular tachycardia (VT) occurred, possibly because of a rapid intracellular shift of potassium mainly explained as refeeding syndrome in addition to potassium removal by hemodialysis. A greater decline of serum phosphate concentrations during hemodialysis on that day compared with that during usual hemodialysis session supports our inference of the contribution of refeeding syndrome to VT complicated with hypokalemia.ConclusionPhysicians should know that IDPN can induce refeeding hypophosphatemia and rapid intracellular shift of potassium. Synergic lowering effects of serum potassium both with intracellular shift caused by refeeding syndrome and potassium removal by hemodialysis might cause lethal arrhythmia in patients treated with IDPN. Before treating malnourished patients with IDPN, the risk of refeeding syndrome should be assessed in patients with high risk of refeeding syndrome.

Use of Intradialytic Parenteral Nutrition in Patients Undergoing Hemodialysis.

Intradialytic parenteral nutrition (IDPN) is a form of supplemental nutrition used to treat patients with malnutrition who receive hemodialysis. Once the diagnosis of malnutrition is made in such patients, encouragement of oral intake is the first-line treatment. If this fails, then enteral or parenteral nutrition may be needed. This review examines the literature on the use of IDPN and summarizes the current recommendations. There is considerable controversy over indications and benefits of IDPN, and well-controlled, long-term studies are needed to help tease out these issues. In the interim, clinical judgment should be used when considering IDPN for individual patients.