Abstract: PO1730
The Beneficial Effects of Intradialytic Parenteral Nutrition in Malnourished Hemodialysis Patients: A Randomized Controlled Trial
Session Information
- Health Maintenance, Nutrition, and Metabolism
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1300 Health Maintenance, Nutrition, and Metabolism
Authors
- Banjongjit, Athiphat, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Metta, Kamonchanok, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Avihingsanon, Yingyos, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Eiam-Ong, Somchai, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Kittiskulnam, Piyawan, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background
Intradialytic parenteral nutrition (IDPN) is an intermittently supplemental nutrition support administered during hemodialysis (HD). IDPN has been suggested as a trial option after a failure response to oral nutritional supplements (ONS). However, the extent to which IDPN contributes to improve protein-energy status remains unclear.
Methods
Maintenance HD patients having spontaneous energy and protein intake of ≥ 20 kcal/kg/day and ≥ 0.8 g/kg/day, respectively and intolerance to ONS were randomly assigned 1:1 to receive IDPN or intensive dietary counselling. In IDPN group, 3-in-1, anti-inflammatory omega 3-rich parenteral nutrition was infused during HD for 3 months followed by a treatment-free period of 3 months. The control group received an individualized dietary counselling once a week for 3 months to target the required nutrient intake. The outcomes were changes in serum albumin, muscle parameters and nutritional biomarkers. Serious adverse events were also monitored.
Results
A total of 38 patients were completed the study (age 67±11). Baseline characteristics were not different between groups. After 3 months, serum albumin were significantly higher in the IDPN (n=18) compared with control group (from 3.5±0.3 to 3.8±0.2 vs 3.6±0.2 to 3.5±0.3 g/dL, p=0.01, respectively). The infusion volume was 14.2±3.9 ml/kg/HD session. Total energy and protein intake (p=0.04), weight (p=0.01), subjective global assessment (p=0.03), and malnutrition inflammation score (p=0.01) were significantly improved in IDPN group, but not in control group (all p>0.05). Among nondiabetic patients, IDPN significantly reduced serum IL-6 as an inflammatory marker (p=0.03) but unaltered serum acylated ghrelin as an orexigenic hormone (p=0.31). Muscle mass, strength, and serum prealbumin were not different between both groups. Participants in IDPN group reverted to baseline albumin levels after 3-month post-intervention follow-up. Neither volume overload nor uncontrolled hyperglycemia was found throughout the study.
Conclusion
A short-term IDPN supplementation significantly increased serum albumin level, a survival surrogate among HD patients. The impact of IDPN therapy on clinical outcomes may require larger scale with longer period of study.