Abstract: TH-PO839
Case Studies of Intradialytic Total Parenteral Nutrition in Nocturnal Home Hemodialysis
Session Information
- Health Maintenance, Nutrition, Metabolism
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance‚ Nutrition‚ and Metabolism
- 1400 Health Maintenance‚ Nutrition‚ and Metabolism
Authors
- Pasricha, Sachin V., University of Toronto, Toronto, Ontario, Canada
- Alqarni, Khaled Abdullah, University of Toronto, Toronto, Ontario, Canada
- Davis, Michael, University of Toronto, Toronto, Ontario, Canada
- Chan, Christopher T., University of Toronto, Toronto, Ontario, Canada
Introduction
Malnutrition occurs in 30-50% of dialysis patients. If unable to meet caloric intake requirements, intradialytic parenteral nutrition (IDPN) may be considered. Standard IDPN occurs thrice weekly with intermittent hemodialysis (IHD), but has yielded heterogeneous clinical results. Nocturnal home hemodialysis (NHD) occurs at a median of 5 nights/week with 8 hours/session. Through longer duration and increased frequency, prescribing IDPN with NHD augments IDPN dose. We present a series of four NHD patients who required intradialytic total parenteral nutrition (IDTPN) as their primary source of caloric intake.
Case Description
1. A 25-year old woman with ANCA-vasculitis on Peritoneal Dialysis (PD) developed encapsulating peritoneal sclerosis (EPS) and a small bowel obstruction (SBO).
2. A 60-year old woman with amyloidosis on NHD had weight loss from amyloidosis.
3. A 46-year old man with cryoglobulinemic vasculitis on NHD needed IDTPN twice for GI symptoms and suboptimal intake.
4. A 59-year old man with IgA-nephropathy on PD developed an EPS-related SBO.
Outcomes: Our patients received 1200-1590 kCal with each IDTPN session and achieved a significant increase in weight, albumin, and BMI (Table 1) (p<0.05 using a Wilcoxon signed rank test). Metabolic complications resembled those with TPN (cramping, hypertriglycidiemia, transaminitis, and fluid overload), and other complications resembled those of the dialysis population (three hospitalizations and one line infection).
Discussion
IDTPN significantly improved nutrition without significant side effects. Our cases are the first example of IDPN being used as the primary source of caloric intake (i.e. IDTPN), which was enabled by longer (≤8 hours) and more frequent (≤7/week) sessions. Our study is novel in its focus on NHD, whereas prior IDPN studies have focused on IHD. We highlight this because NHD enables diet liberalization and enhances quality of life, both relevant to malnourished patients. Finally, NHD with IDTPN may be particularly useful for PD patients with EPS, as they need to switch dialysis modality and start parenteral nutrition, but presumably prefer to dialyze at home.