Intradialytic parenteral nutrition in malnourished hemodialysis patients: A prospective long-term study

Background: Malnutrition is a frequent problem of patients on intermittent hemodialysis and substantially contributes to their morbidity and mortality . Methods: In 26 hemodialysis patients who, despite dietary advice and oral nutritional supplements, still had malnutrition, the feasibility and effec ts of a specific intradialytic parenteral nutritional (IPN) regimen were ev aluated during a 9-month study period. An IPN solution consisting of 250 mt glucose 50%, 250 mt lipids 20%, and 250 mL amino acids 7% was infused IV t hree times a week during the dialysis session. At the end of each dialysis session an additional volume of 250 mt amino acids was infused as a rinsing fluid. Insulin was administered TV before dialysis. Results: Of the 26 enr olled patients, 16 completed the study. The remaining 10 patients withdrew mainly because of muscle cramps and nausea during the initiation phase of t he treatment, when sodium was not present in the TPN fluid but was suppleme nted intermittently. In the 16 treated patients, body weight, which had dec reased in the pretreatment period from 58.2 +/- 1.3 kg (-6 months) to 54.8 +/- 10.1 kg at the start of the study, increased again up to 57.1 +/- 10.7 kg after 9 months IPN (p < .05). Serum transferrin and prealbumin rose from 1.7 +/- 0.4 to 2.0 +/- 0.4 g/L and from 0.23 +/- 0.05 to 0.27 +/- 0.10 g/L , respectively. Bone densitometry showed an increase of tissue mass, mostly related to a rise in fat tissue. Triceps skinfold (p < .05) and arm muscle compartment of the midarm (p = .01) increased as well. No such changes wer e observed in the patients who withdrew from treatment. Conclusions: An IV hyperalimentation regimen applied to malnourished hemodialysis patients res ults in a rise of body weight and in a limited, but significant, change of some parameters of nutritional status. The rise in body weight is at least in part attributable to an increase of body fat, without changes in plasma lipid levels.