PROLONGED USE OF INTRADIALYSIS PARENTERAL-NUTRITION IN ELDERLY MALNOURISHED CHRONIC-HEMODIALYSIS PATIENTS

Background. The treatment of malnutrition, frequently present in elder ly dialysis patients, is important to promote better quality of life a nd rehabilitation. The aim of this study was to assess the impact of p rolonged use of intradialysis parenteral nutrition (IDPN) as a strateg y for malnutrition in elderly haemodialysis patients. Methods. Twenty- eight elderly patients (non-diabetic, age over 70) on chronic haemodia lysis for at least 2 years were evaluated. Ten consenting patients wer e treated with IDPN containing glucose, essential amino acids, and lip id emulsion during the course of regularly scheduled dialysis treatmen ts for approximately 1 year. Nutritional evaluation using seven parame ters (anthropometric measurements such as body mass index, triceps ski nfold thickness, mid-arm circumference, midarm muscle circumference, a nd albumin, transferrin, and total lymphocyte count) was performed at various intervals on patients with IDPN and 18 patients without IDPN. The plasma amino-acid profile and dietary protein calorie intake were also determined. Results. In patients receiving IDPN, significant incr eases in serum albumin and transferrin concentrations and total lympho cyte count in peripheral blood smears paralleled increases in protein- calorie intake beginning after 3 months of treatment and remained favo urable throughtout the study period. Anthropometric data started to im prove significantly after 6 months of treatment. Patients without IDPN had gradual decreases in all parameters during the study period. A si gnificant increase in essential amino acids and a significant decrease in 3-methyl-histidine were observed in patients with IDPN and a furth er decrease in essential amino acids was observed in patients without IDPN. Conclusion. Prolonged use of IDPN prevents muscle protein catabo lism and promotes body protein and fat accumulation. IDPN appears to b e effective in malnourished elderly haemodialysis patients.