Intradialytic Parenteral Nutrition in Malnourished Hemodialysis Patients: A Prospective Long-Term Study

Abstract

Background: Malnutrition is a frequent problem of patients on intermittent hemodialysis and substantially contributes to their morbidity and mortality. Methods: In 26 hemodialysis patients who, despite dietary advice and oral nutritional supplements, still had malnutrition, the feasibility and effects of a specific intradialytic parenteral nutritional (IPN) regimen were evaluated during a 9-month study period. An IPN solution consisting of 250 mL glucose 50%, 250 mL lipids 20%, and 250 mL amino acids 7% was infused IV three times a week during the dialysis session. At the end of each dialysis session an additional volume of 250 mL amino acids was infused as a rinsing fluid. Insulin was administered IV before dialysis. Results: Of the 26 enrolled patients, 16 completed the study. The remaining 10 patients withdrew mainly because of muscle cramps and nausea during the initiation phase of the treatment, when sodium was not present in the IPN fluid but was supplemented intermittently. In the 16 treated patients, body weight, which had decreased in the pretreatment period from 58.2 ± 1.3 kg (-6 months) to 54.8 ± 10.1 kg at the start of the study, increased again up to 57.1 ± 10.7 kg after 9 months IPN (p < .05). Serum transferrin and prealbumin rose from 1.7 ± 0.4 to 2.0 ± 0.4 g/L and from 0.23 ± 0.05 to 0.27 ± 0.10 g/L, respectively. Bone densitometry showed an increase of tissue mass, mostly related to a rise in fat tissue. Triceps skinfold (p < .05) and arm muscle compartment of the midarm (p = .07) increased as well. No such changes were observed in the patients who withdrew from treatment. Conclusions: An IV hyperalimentation regimen applied to malnourished hemodialysis patients results in a rise of body weight and in a limited, but significant, change of some parameters of nutritional status. The rise in body weight is at least in part attributable to an increase of body fat, without changes in plasma lipid levels. (Journal of Parenteral and Enteral Nutrition 23:90-95, 1999)