Intradialytic Parenteral Nutrition in Patients on Hemodialysis: A Multicenter Retrospective Study

Abstract

Background and objective: To evaluate the effectiveness and safety of intradialytic parenteral nutrition (IDPN) on different nutritional outcomes.

Methods: This was a retrospective analysis for a "routinely collected data bank" in a multicenter cohort, conducted on consecutive malnourished or at-risk of malnutrition patients with chronic kidney disease on hemodialysis who underwent IDPN with a three-in-one parenteral nutrition formula for a period ≥ 2 weeks. The primary endpoint was the mean change in the malnutrition inflammation score (MIS) score between baseline and the last follow-up visit on IDPN.

Results: Fifty-six patients were included. The mean age was 72.4 ± 12.0 years, and 24 (42.9%) were women. In the overall study sample, MIS significantly decreased from 16.4 (95%CI: 15.3-17.65) at baseline to 14.3 (95%CI: 12.8-15.8) at the last follow-up visit on IDPN (p = 0.0019). Fifteen (26.8%) patients achieved a MIS reduction ≥ 5 points after IDPN. As compared to baseline, IDPN significantly reduced the proportion of patients with protein-energy wasting (PEW) (89.3% versus 66.1%, respectively, p = 0.0023). Regarding analytical parameters, serum albumin (p = 0.0003) and total proteins (p = 0.0024) significantly increased after IDPN administration. Throughout the study's follow-up period, 45 (80.4%) patients reported experiencing some type of adverse event.

Conclusions: IDPN was associated with a significant improvement in the nutritional profile. Notably, our research found that the administration of IDPN over a duration > 3 months significantly improved the nutritional status of patients evaluated by the MIS test.

Keywords: chronic kidney disease; hemodialysis; intradialytic parenteral nutrition; malnutrition inflammation score; protein-energy wasting.

Figure 1

Flow chart of the patients included in this study. IDPN: Intradialitic parenteral nutrition. Center 1: Hospital Clinic; Center 2: Hospital de Mollet; Center 3: Fundació Puigvert; Center 4: Hospital del Mar-Parc de Salut Mar; Center 5: Corporació Sanitaria Parc Taulí; Center 6: Hospital Universitari Dr. J Trueta; and Center 7: Hospital Universitari Joan XXIII.

Figure 2

Mean malnutrition inflammation score at baseline and at the last follow-up visit on intradialytic parenteral nutrition. Mean difference: −2.1 ± 4.8; 95% confidence interval: −3.5 to −8.0; p = 0.0019.