INTRADIALYTIC PARENTERAL-NUTRITION IN MALNOURISHED PATIENTS ON CHRONIC-HEMODIALYSIS THERAPY

Background. Malnutrition is frequently encountered in patients on regu lar haemodialysis therapy and presents an important determinant of mor bidity and mortality. Usual therapeutic approaches to alleviate malnut rition have been unsuccessful. The objective of this study was to asse ss the impact of intradialytic parenteral nutrition (IDPN) with amino acids (in combination with a glucose-containing dialysate) on nutritio nal parameters and immunocompetence in patients on regular haemodialys is treatment. Methods. Effects of IDPN were evaluated in 16 malnourish ed patients. After a run-in period of 4 weeks (to define stable baseli ne conditions) 0.8 g amino acids/kg bodyweight using a novel amino-aci d solution (adapted to metabolic alteration of uraemia and including t he dipeptide glycyl-tyrosine as tyrosine source) was infused thrice we ekly during each haemodialysis session for 16 weeks. Results. Intradia lytic amino-acid infusion was well tolerated and the dipeptide was rap idly utilized with only traces being detectable in plasma after dialys is. Visceral protein synthesis was improved, serum albumin, prealbumin , and cholinesterase increased during IDPN (P<0.05). As indicators of augmented immunocompetence skin test reactivity against multiple antig ens was improved (P<0.02) and total lymphocyte count was raised (P<0.0 5). Plasma amino acid pattern did not deteriorate but failed to normal ize during IDPN and phenylalanine/tyrosine ratio remained stable. Anth ropometric measurements and eating behaviour as assessed by dietary re cords were not altered during IDPN. Conclusions. Even using a simple a nd limited intradialytic nutritional support with amino acids can impr ove visceral protein status and stimulate immunocompetence in malnouri shed patients on regular haemodialysis therapy.