Assessment of Outcomes of Intradialytic Parenteral Nutrition

Context

Patients with end-stage renal disease often suffer from malnutrition. One modality used to treat malnourished hemodialysis patients is intradialytic parenteral nutrition (IDPN), a multi-component nutritional supplement.

Objectives

The primary outcome of this trial was to determine the effects of IDPN on weight and serum albumin in a large tertiary-care institution.

Setting

A 160 bed hospital-based hemodialysis unit.

Design

All patients who received IDPN for greater than 1 month from program inception in June 1997 to December 2000 were analyzed. Patients received IDPN as amino acid 10% 250mL or 500mL, dextrose 50% 250mL and fat emulsion 20% 250mL. IDPN was administered during each hemodialysis run three times weekly. Data was collected at 6 and 3 months prior to IDPN administration as well as at baseline, 3, 6, 9, and 12 months post-therapy.

Main Outcome Measures

Therapeutic efficacy was assessed by percent change from baseline of dry weight and serum albumin.

Results

Twenty-six courses of IDPN in 24 patients met inclusion criteria. The mean duration of treatment was 4.3 months. A significant decline in dry weight was observed at both 6 and 3 months prior to IDPN initiation. Dry weight increased from baseline and achieved significance at 6, 9 and 12 months post-therapy. Serum albumin also significantly improved from baseline at 3 and 9 months. Compared to baseline, there was a 3 to 5-fold increase in the percent of patients with serum albumin greater than or equal to 34g/L. Adverse drug reactions consisted primarily of excess fluid gain and hyperglycemia.

Conclusions

IDPN significantly increased both weight and serum albumin in malnourished hemodialysis patients.

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