Intradialytic parenteral nutrition and intraperitoneal nutrition are
methods to provide supplemental nutrition support to patients with chronic
kidney disease (also referred to as end-stage renal disease) while they are
receiving dialytic therapy. There has been considerable controversy over
indications and benefits of intradialytic parenteral nutrition and
intraperitoneal nutrition. A major stumbling block had been problematic
reimbursement for the therapy under Medicare. Medicare Part D has alleviated
some of the reimbursement obstacles and has increased interest in reexamining
the benefits and burdens of supplemental nutrition support therapies for
patients receiving dialysis.
Get full access to this article
View all access options for this article.
References
1.
Global dialysis: dialysis standards and statistics.
http://globaldialysis.com/stats.asp.
Updated March 1, 2007. Accessed September 28, 2008.
2.
Mehrotra R, Kopple J. Nutritional management of maintenance
dialysis patients: why aren't we doing better? Annu Rev
Nutr. 2001;21:343
-380.
3.
Wang AY, Sanderson J, Sea MM, et al. Important factors other than
dialysis adequacy associated with inadequate dietary protein and energy
intakes in patients receiving maintenance peritoneal dialysis. Am J
Clin Nutr. 2003;77:834
-841.
4.
Davies SJ, Russell L, Bryan J, Phillips L, Russell GI. Comorbidity,
urea kinetics, and appetite in continuous ambulatory peritoneal dialysis:
their interrelationship and prediction of survival. Am J Kidney
Dis. 1995;26:353
-361.
5.
Capelli JP, Kushner H, Camiscioli TC, Chen S, Torres MA. Effect of
intradialytic parenteral nutrition on mortality rates in end-stage renal
disease care. Am J Kidney Dis.1994
;23:808
-816.
6.
Centers for Medicare and Medicaid, Department of Health and Human
Services. Conditions for Coverage for ESRD Facilities, 42 CFR Part
494. Fed Regist. April15,2008
. Effective October 14, 2008.
7.
Fuhrman MP, Charney P, Mueller C. Hepatic proteins and nutrition
assessment. J Am Diet assoc.2004
;104:1258
-1264.
8.
Kaysen A, Levin NW. Why measure serum albumin levels? J
Ren Nutr. 2002;12:148
-150.
9.
Kaysen GA, Dubin JA, Muller HG, Rosales L, Levin NW, Mitch WE. HEMO
Study Group. Inflammation and reduced albumin synthesis associated with stable
decline in serum albumin in hemodialysis patients. Kidney
Int. 2004;65:1408
-1415.
10.
Fein PA, Mittman N, Gadh R, et al. Malnutrition and inflammation in
peritoneal dialysis patients. Kidney Int.2003
;64(suppl 87):S87
-S91.
11.
Gabay C, Kushner I. Acute phase proteins and other systemic
responses to inflammation. N Engl J Med.1999
;340:448
-454.
12.
Lacson E, Ikizler A, Lazarus M, Teng M, Hakim RM. Potential impact
of nutritional intervention on end-stage renal disease hospitalization, death,
and treatment costs. J Ren Nutr.2007
;17:363
-371.
13.
Riella MC. Malnutrition in dialysis: malnourishment or uremic
inflammatory response? Kidney Int.2000
;57:1211
-1232.
14.
Chertow GM, Ling J, Lew NL, Lazarus JM, Lowrie EG. The association
of intradialytic parenteral nutrition administration with survival in
hemodialysis patients. Am J Kidney Dis.1994
;24:912
-920.
15.
Moore E, Celano J. Challenges of providing nutrition support in the
outpatient dialysis setting. Nutr Clin Pract.2005
;20:202
-212.
16.
How PP, Lau AH. Malnutrition in patients undergoing hemodialysis:
is intradialytic parenteral nutrition the answer?
Pharmacotherapy.2004
;24:1748
-1758.
17.
Gil H, Yang J, Lee E, Lee E, Choi JS, Hong S. The effect of
dialysis membrane flux on amino acid loss in hemodialysis patients.
J Korean Med Sci.2007
;22:598
-603.
18.
Malgorzewicz S, Debska-Slizien A, Rutkowski B, Lysiak-Szydlowska W.
Serum concentration of amino acids versus nutritional status in hemodialysis
patients. J Ren Nutr.2008
;18:239
-247.
19.
Bossola M, Muscaritoli M, Tazza L, et al. Malnutrition in
hemodialysis patients: what therapy? Am J Kid Dis.2005
;46:371
-386.
20.
Jones MR, Gehr TW, Burkart JM, et al. Replacement of amino acid and
protein losses with 1.1% amino acid peritoneal dialysis solution.
Perit Dial Int.1998
;18:210
-216.
21.
Utaka S, Avesani CM, Draibe SA, Kamimura MA, Andreoni S, Cuppari L.
Inflammation is associated with increased energy expenditure in patients with
chronic kidney disease. Am J Clin Nutr.2005
;82:801
-805.
22.
Ramkumar N, Cheung AK, Pappas LM, Roberts WL, Beddhu S. Association
of obesity with inflammation in chronic kidney disease: a cross-sectional
study. J Ren Nutr.2004
;14:201
-207.
23.
Honda H, Qureshi AR, Heimburger O, et al. Serum albumin, C-reactive
protein, interleukin 6, and fetuin A as predictors of malnutrition,
cardiovascular disease, and mortality in patients with ESRD. Am J
Kidney Dis. 2006;47:139
-148.
24.
Qureshi AR, Alvestrand A, Divino-Filho JC, et al. Inflammation,
malnutrition, and cardiac disease as predictors of mortality in hemodialysis
patients. J Am Soc Nephrol.2002
;13(suppl 1):S28
-S36.
25.
Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing
outcome predictability of markers of malnutrition-inflammation complex
syndrome in hemodialysis patients. Nephrol Dial
Transplant. 2004;19:1507
-1519.
26.
Ikizler TA, Wingard RL, Harvell J, Shyr Y, Hakim RM. Association of
morbidity with markers of nutrition and inflammation in chronic hemodialysis
patients: a prospective study. Kidney Int.1999
;55:1945
-1951.
27.
Ho LC, Wang HH, Peng YS, et al. Clinical utility of
malnutrition-inflammation score in maintenance hemodialysis patients: focus on
indentifying the best cut-off point. Am J Nephrol.2008
;28:840
-846.
28.
Afsar B, Sezer S, Ozdemir FN, Celik H, Elsurer, Haberal, M.
Malnutrition-inflammation score is a useful tool in peritoneal dialysis
patients. Perit Dial Int.2006
;26:705
-711.
29.
Caglar K, Fedje L, Dimmitt R, Hakim RM, Shyr Y, Ikizler A.
Therapeutic effects of oral nutritional supplementation during hemodialysis.
Kidney Int.2002
;62:1054
-1059.
30.
Veeneman JM, Kingma HA, Boer TS, et al. Protein intake during
hemodialysis maintains a positive whole body protein balance in chronic
hemodialysis patients. Am J Physiol Endocrinol Metab.2003
;284:E954
-E965.
31.
Azar R, Smessaert C, Clicteur K, et al. Effects of oral nutritional
supplementation on nutritional status in malnourished chronic hemodialysis
patients [abstract]. J Ren Nutr.2008
;18:S33
.
32.
Stratton R, Bircher G, Fouque D, et al. Multinutrient oral
supplements and tube feeding in maintenance dialysis: a systematic review and
meta-analysis. Am J Kidney Dis.2005
;46:387
-405.
33.
National Kidney Foundation. K/DOQI clinical practice guidelines for
nutrition in chronic renal failure. Am J Kidney Dis.2000
;35(suppl):S1
-S104.
34.
A.S.P.E.N. Board of Directors and The Clinical Guidelines Task
Force. Guidelines for the use of parenteral and enteral nutrition in adult and
pediatric patients [published correction in JPEN 2002; 26:144].
JPEN J Parenter Enteral Nutr.2002
;26(suppl):1SA
-138SA.
35.
McCann L, ed. Pocket Guide to Nutrition Assessment of
the Patient with Chronic Kidney Disease. 4th ed. New York, NY:
National Kidney Foundation, 2009.
36.
Fuhrman MP. Parenteral nutrition in kidney disease. In: Byham-Gray
L, Wiesen K, eds. A Clinical Guide to Nutrition Care in Kidney
Disease. Chicago, IL: American Dietetic Association;2004
: 159-174.
37.
Moore E, Lindenfield SM. Intradialytic parenteral nutrition: a
nutrition support intervention for high-risk malnutrition in chronic kidney
disease. Support Line.2007
;29:6
-13,16.
38.
Serna-Thome MG, Padilla-Rosciano AE, Suchi-Bernal L. Practical
aspects of intradialytic nutritional support. Curr Opin Clin Nutr
Metab Care. 2002;5:293
-296.
39.
Hakim RM. Proposed clinical trials in the evaluation of
intradialytic parenteral nutrition. Am J Kidney Dis.1999
;33:217
-220.
40.
Lazarus MJ. Recommended criteria for initiation and discontinuing
intradialytic parenteral nutrition therapy. Am J Kidney
Dis. 1999;33:211
-216.
41.
Detsky A, McLaughlin J, Baker J. What is subjective global
assessment of nutritional status? JPEN J Parenter Enteral
Nutr. 1987;11:8
-13.
42.
Pupim LB, Majchrzak KM, Flakoll PJ, Ikizler TA. Intradialytic oral
nutrition improves protein homeostasis in chronic hemodialysis patients with
deranged nutritional status. J Am Soc Nephrol.2006
;17:3149
-3157.
43.
Hiroshige K, Iwamoto M, Kabashima N, Mutoh Y, Yuu K, Ohtani A.
Prolonged use of intradialysis parenteral nutrition in elderly malnourished
chronic hemodialysis patients. Nephrol Dial
Transplant. 1998;13:2081
-2087.
44.
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin
therapy in the critically ill patients. N Engl J Med.2001
;345:1359
-1367.
45.
Fuhrman MP. Complication management in parenteral nutrition. In:
Matarese LE, Gottschlich MM, eds. Contemporary Nutrition Support
Practice: A Clinical Guide, 2nd ed. Philadelphia, PA: Saunders,2003
: 242-262.
46.
Hise ME, Brown JC. Lipids. In: Gottschlich MM, ed. The
A.S.P.E.N. Nutrition Support Core Curriculum: A Case-Based Approach—The
Adult Patient. Silver Spring, MD: The American Society for
Parenteral and Enteral Nutrition. 2007:48
-70.
47.
Pupim LB, Flakoll PJ, Ikizler TA. Nutritional supplementation
acutely increases albumin fractional synthetic rate in chronic hemodialysis
patients. J Am Soc Nephrol.2004
;15:1920
-1926.
48.
Pupim LB, Flakoll PJ, Levenhagen DK, Ikizler TA. Exercise augments
the acute anabolic effects of intradialytic parenteral nutrition in chronic
hemodialysis patients. Am J Physiol Endocrinol Metab.2004
;286:E589
-E597.
49.
Pupim LB, Flakoll PJ, Yu C, Ikizler TA. Recombinant human growth
hormone improves muscle amino acid uptake and whole-body protein metabolism in
chronic hemodialysis patients. Am J Clin Nutr.2005
;82:1235
-1243.
50.
Cano NJM, Fouque D, Roth H, et al. Intradialytic parenteral
nutrition does not improve survival in malnourished hemodialysis patients: a
2-year multicenter, prospective, randomized study. J Am Soc
Nephrol. 2007;18:2583
-2591.
51.
Dezfuli A, Ricker M, Scholl D, Lindenfeld SM, Kalantar-Zadeh.
Severity of hypoalbuminemia is related to the effectiveness of intradialytic
parenteral nutrition (IDPN) in hemodialysis patients [abstract]. J
Ren Nutr. 2008;18:S33
.
52.
Scholl D, Dowling R, Ricker M, Lindenfeld S. Intradialytic
parenteral nutrition (IDPN): changes in albumin, total protein, dry weight,
BUN, and creatinine after 3 to 12 months of therapy [abstract]. J
Ren Nutr. 2007;17:162
.
53.
Smolle KH, Kaufmann P, Holzer H, Druml W. Intradialytic parenteral
nutrition in malnourished patients on chronic haemodialysis therapy.
Nephrol Dial Transplant.1995
;10:1411
-1416.
54.
Krause I, Shamir R, Davidovits M, et al. Intradialytic parenteral
nutrition in malnourished children treated with hemodialysis. J Ren
Nutr. 2002;12:55
-59.
55.
Madigan KM, Olshan A, Yingling DJ. Effectiveness of intradialytic
parenteral nutrition in diabetic patients with end-stage renal disease.
J Am Diet assoc.1990
;90:861
-863.
56.
Joannidis M, Rauchenzauner M, Leiner B, et al. Effect of
intradialytic parenteral nutrition in patients with malnutrition-inflammation
complex syndrome on body weight, inflammation, serum lipids and
adipocytokines: results from a pilot study. Eur J Clin
Nutr. 2008;62:789
-795.
57.
Orrellana P, Juarez-Congelosi M, Goldstein SL. Intradialytic
parenteral nutrition treatment and biochemical marker assessment for
malnutrition in adolescent maintenance hemodialysis patients. J Ren
Nutr. 2005;15:312
-317.
58.
Srivaths PR, Wong C, Goldstein SL. Nutrition aspects in children
receiving maintenance hemodialysis: impact on outcome. Pediatr
Nephrol. 2009;24:951
-957.
59.
Garibotto G, Sofia A, Canepa A, et al. Acute effects of peritoneal
dialysis with dialysates containing dextrose or dextrose and amino acids on
muscle protein turnover in patients with chronic renal failure. J
Am Soc Nephrol. 2001;12:557
-567.
60.
Jones M, Hagen T, Boyle CA, et al. Treatment of malnutrition with
1.1% amino acid peritoneal dialysis solution: results of a multicenter
outpatient study. Am J Kidney Dis.1998
;32:761
-769.
61.
Kopple JD, Bernard D, Messana J, et al. Treatment of malnourished
CAPD patients with an amino acid based dialysate. Kidney
Int. 1995;47:1148
-1157.
62.
Taylor GS, Patel V, Spencer S, Fluck RJ, McIntyre CW. Long-term use
of 1.1% amino acid dialysis solution in hypoalbuminemic continuous ambulatory
peritoneal dialysis patients. Clin Nephrol.2002
;58:445
-450.
63.
Tjiong HL, Rietveld T, Wattimena JL, et al. Peritoneal dialysis
with solutions containing amino acids plus glucose promotes protein synthesis
during oral feeding. Clin J Am Soc Nephrol.2007
;2:74
-80.
64.
Faller B, Aparicio M, Faict D, et al. Clinical evaluation of an
optimized 1.1% amino-acid solution for peritoneal dialysis. Nephrol
Dial Transplant. 1995;10:1432
-1437.
65.
Afreen S, Goodship THJ, Kirkwood A, Ward MK. The
nutritional/metabolic and hormonal effects of 8 weeks of continuous ambulatory
peritoneal dialysis with a 1% amino acid solution. Clin
Nephrol. 1990;33:192
-199.
66.
Bruno M, Bagnis C, Marangella M, Rovera L, Cantaluppi A, Linari F.
CAPD with an amino acid dialysis solution: a long-term cross-over study.
Kidney Int.1989
;35:1189
-1194.
67.
Young GA, Dibble JB, Hobson SM, Tompkins L, Gibson J, Turney JH.
The use of an amino-acid-based CAPD fluid over 12 weeks. Nephrol
Dial Transplant. 1989;4:285
-292.
68.
McCann L. Nutrition management of the adult peritoneal dialysis
patient. In: Byham-Gray L, Wiesen K, eds. A Clinical Guide to
Nutrition Care in Kidney Disease. Chicago, IL: American Dietetic
Association; 2004: 57-69.
