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Intradialytic parenteral nutrition in end-stage renal disease: practical aspects, indications and limits

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Abstract

Protein-energy malnutrition (PEW) is highly prevalent in patients with end-stage renal disease (ESRD) and is associated with a significant increase of the already high mortality and morbidity risk typical of this clinical setting. Since a key mechanism of PEW in ESRD is inadequate nutrient intake, oral nutritional supplements are extensively employed, and have been demonstrated to be highly effective in PEW prevention and treatment. Intradialytic parenteral nutrition (IDPN), i.e. the administration of nutrients through the extracorporeal circuit during hemodialysis, has also been proposed as a modality of nutritional support for patients with ESRD. However, even though metabolic/nutritional status is improved by this nutritional approach, the evidence linking IDPN to decreased hospitalization rate and lower mortality risk is still scant. The aim of the present paper is to review the role of IDPN as a modality of nutritional supplementation for ESRD patients on hemodialysis. To this end, quantitative and qualitative aspects, practical management, the indications, and limits of IDPN are discussed. On the basis of the available evidence, it is suggested that IDPN is a safe and efficacious modality of nutritional support in ESRD, and could represent an adjunctive strategy for patients with reduced spontaneous dietary intake when intensive dietetic counseling and oral supplementation have failed.

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References

  1. Fouque D, Kalantar-Zadeh K, Kopple J et al (2008) A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 73:391–398

    Article  CAS  PubMed  Google Scholar 

  2. Carrero JJ, Stenvinkel P, Cuppari L et al (2013) Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr 23:77–90

    Article  PubMed  Google Scholar 

  3. Ikizler TA, Cano NJ, Franch H et al (2013) Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. doi:10.1038/ki.2013.147 (in press)

    PubMed Central  Google Scholar 

  4. Kalantar-Zadeh K, Rhee C, Sim JJ, Stenvinkel P, Anker SD, Kovesdy CP (2013) Why cachexia kills: examining the causality of poor outcomes in wasting conditions. J Cachexia Sarcopenia Muscle 4:89–94

    Article  PubMed Central  Google Scholar 

  5. Bossola M, Tazza L, Giungi S, Luciani G (2006) Anorexia in hemodialysis patients: an update. Kidney Int 70:417–422

    CAS  PubMed  Google Scholar 

  6. Fouque D, Laville M (2009) Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database of Syst Rev 3:CD001892

    Google Scholar 

  7. Kovesdy CP, Kopple JD, Kalantar-Zadeh K (2013) Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr 97:1163–1177

    Article  CAS  PubMed Central  Google Scholar 

  8. Kalantar-Zadeh K, Cano NJ, Budde K et al (2011) Diets and enteral supplements for improving outcomes in chronic kidney disease. Nat Rev Nephrol 7:369–384

    Article  CAS  PubMed  Google Scholar 

  9. Lacson E Jr, Wang W, Zebrowski B, Wingard R, Hakim RM (2012) Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: a quality improvement report. Am J Kidney Dis 60:591–600

    Article  CAS  PubMed  Google Scholar 

  10. Cheu C, Pearson J, Dahlerus C et al (2013) Association between oral nutritional supplementation and clinical outcomes among patients with ESRD. Clin J Am Soc Nephrol 8:100–107

    Article  PubMed Central  PubMed  Google Scholar 

  11. Cano N, Aparicio M, Brunori G et al (2009) ESPEN guidelines on parenteral nutrition: adult renal failure. Clin Nutr 28:401–414

    Article  CAS  PubMed  Google Scholar 

  12. Dukkipati R, Kalantar-Zadeh K, Kopple JD (2010) Is there a role for intradialytic parenteral nutrition? A review of the evidence. Am J Kidney Dis 55:352–364

    Article  Google Scholar 

  13. National Kidney Foundation (2000) K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 35(suppl):S1–S104

    Google Scholar 

  14. Tattersall J, Martin-Malo A, Pedrini L (2007) EBPG guideline on dialysis strategies. Nephrol Dial Transplant 22:ii5–ii21

    Article  Google Scholar 

  15. Ikizler TA, Flakoll PJ, Parker RA, Hakim RM (1994) Amino acid and albumin losses during hemodialysis. Kidney Int 46:830–837

    Article  CAS  PubMed  Google Scholar 

  16. Wolfson M, Jones MR, Kopple JD (1982) Amino acid losses during hemodialysis with infusion of amino acids and glucose. Kidney Int 21:500–506

    Article  CAS  PubMed  Google Scholar 

  17. Capelli JP, Kushner H, Camiscioli TC, Chen S, Torres MA (1994) Effect of intradialytic parenteral nutrition on mortality rates in end-stage renal disease care. Am J Kidney Dis 23:808–816

    Article  CAS  PubMed  Google Scholar 

  18. Chertow GM, Ling J, Lew NL et al (1994) The association of intradialytic parenteral nutrition administration with survival in hemodialysis patients. Am J Kidney Dis 24:912–920

    Article  CAS  PubMed  Google Scholar 

  19. Hiroshige K, Iwamoto M, Kabashima N, Mutoh Y, Yuu K, Ohtani A (1998) Prolonged use of intradialysis parenteral nutrition in elderly malnourished chronic hemodialysis patients. Nephrol Dial Transplant 13:2081–2087

    Article  CAS  PubMed  Google Scholar 

  20. Cherry N, Shalansky K (2002) Efficacy of intradialytic parenteral nutrition in malnourished hemodialysis patients. Am J Health Syst Pharm 59:1736–1741

    CAS  PubMed  Google Scholar 

  21. Joannidis M, Rauchenzauner M, Leiner B et al (2008) 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 62:789–795

    Article  CAS  PubMed  Google Scholar 

  22. Dezfuli A, Scholl D, Lindenfeld SM, Kovesdy CP, Kaantar-Zadeh K (2009) Severity of hypoalbuminemia predicts response to intradialytic parenteral nutrition in hemodialysis patients. J Ren Nutr 19:291–297

    Article  CAS  PubMed  Google Scholar 

  23. Cano N, Labastie-Coeyrehourq J, Lacombe P et al (1990) Perdialytic parenteral nutrition with lipids and amino acids in malnourished hemodialysis patients. Am J Clin Nutr 52:726–730

    CAS  Google Scholar 

  24. Cano NJ, Saingra Y, Dupuy AM et al (2006) Intradialytic parenteral nutrition: comparison of olive oil versus soybean oil-based lipid emulsions. Br J Nutr 95:152–159

    Article  CAS  Google Scholar 

  25. Cano N, Fouque D, Roth H, The French Study Group for Nutrition in Dialysis et al (2007) Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol 18:2583–2591

    Article  CAS  Google Scholar 

  26. Pupim LB, Flakoll PJ, Brouillette JR et al (2002) Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients. J Clin Invest 110:483–492

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Pupim LB, Flakoll PJ, Ikizler TA (2004) Nutritional supplementation acutely increases albumin fractional synthetic rate in chronic hemodialysis patients. J Am Soc Nephrol 15:1920–1926

    Article  CAS  PubMed  Google Scholar 

  28. Pupim LB, Flakoll PJ, Levenhagen DK, Ikizler TA (2004) Exercise augments the acute anabolic effects of intradialytic parenteral nutrition in chronic hemodialysis patients. Am J Physiol Endocrinol Metab 286:E589–E597

    Article  CAS  Google Scholar 

  29. Ikizler TA, Pupim LB, Brouillette JR et al (2002) Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation. Am J Physiol Endocrinol Metab 282:E107–E116

    CAS  PubMed  Google Scholar 

  30. Pupim LB, Majchrzak KM, Flakoll PJ, Ikizler TA (2006) Intradialytic oral nutrition improves protein homeostasis in chronic hemodialysis patients with deranged nutritional status. J Am Soc Nephrol 17:3149–3157

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by the Association for Research in Kidney Disease “Parma per il Rene ONLUS”.

Conflict of interest

The authors have no conflict of interest to be disclosed.

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Authors and Affiliations

  1. Renal Unit, Department of Clinical and Experimental Medicine, Parma University Medical School, Parma, Italy

    Alice Sabatino, Giuseppe Regolisti, Elio Antonucci, Aderville Cabassi & Enrico Fiaccadori

  2. Nephrology and Dialysis Unit, Roma “La Sapienza” University, Rome, Italy

    Santo Morabito

Authors
  1. Alice Sabatino
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  2. Giuseppe Regolisti
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  3. Elio Antonucci
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  4. Aderville Cabassi
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  5. Santo Morabito
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  6. Enrico Fiaccadori
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Correspondence to Enrico Fiaccadori.

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Sabatino, A., Regolisti, G., Antonucci, E. et al. Intradialytic parenteral nutrition in end-stage renal disease: practical aspects, indications and limits. J Nephrol 27, 377–383 (2014). https://doi.org/10.1007/s40620-014-0051-6

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  • DOI: https://doi.org/10.1007/s40620-014-0051-6

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