Is Intradialytic
Parenteral Nutrition of benefit to malnourished haemodialysis patients?
E Challand, G Hartley, M Murray
Problem: Intradialytic parenteral nutrition (IDPN) has routinely been used in our unit to provide additional calories and nitrogen to malnourished haemodialysis patients. However, the benefits to our patients of this treatment have not been established.
Purpose: To evaluate the use of IDPN in haemodialysis patients attending our dialysis units.
Design: A retrospective review of all patients receiving IDPN over a 12-month period was undertaken. Patient characteristics, relevant treatment details, nutritional status prior to commencing IDPN, together with any changes during IDPN treatment, and patient survival were determined.
Results: Eleven patients (4 male) with a mean age of 64 years (range 48 - 80), including 1 diabetic patient, received IDPN during the 12-month review period. IDPN was administered for a median duration of 9 weeks (range 1 - 20). All patients had been receiving 3/week dialysis (prescribed eKt/V=1.2) for a minimum of 3 months prior to starting lDPN, and were identified as having a poor appetite together with reduced nutritional markers (BMI <18.5kg/m2 and/or >10% oedema-free weight loss in 6 months and/or serum albumin <35g/L (Bromocresol green assay)). No consistent improvements in any of these nutritional markers were seen with IDPN treatment. Reasons for discontinuing IDPN were improved oral intake (4 patients), poor tolerance of IDPN (3 patients), conversion to nasogastric feeding / total parenteral nutrition (2 patients), or patient died (2 patients). Six months after stopping IDPN 4 patients were managed by oral diet alone and 7 patients had died.
Conclusion: Although limited by its small, uncontrolled and retrospective nature, this review found no benefit in treating malnourished haemodialysis patients with IDPN.
Relevance: This evaluation
of IDPN, together with the poor evidence base found in the literature to
support its efficacy, has led to IDPN no longer being used within our unit.