Recommended criteria for initiating and discontinuing intradialytic parenteral nutrition therapy

The indications for intradialytic parenteral nutrition (IDPN) in patients w ith end-stage renal disease remain controversial. Medicare has taken a posi tion to severely limit the use of this form of nutritional therapy. Are the re patients who do not meet the government criteria, yet would benefit from this therapy? Studies are required to answer this question, but they may b e years away. In the interim, identification of appropriate patients, devel opment of appropriate criteria for initiating and discontinuing therapy, as well as a proper reimbursement process should be considered for the treatm ent of severe malnutrition in this population of patients. This article dis cusses these topics and outlines a different approach to the use of IDPN. ( C) 1999 by the National Kidney Foundation, Inc.