Effect of intradialytic parenteral nutrition on delivered Kt V

The purpose of the study is to determine the effect of intradialytic parent eral nutrition (IDPN) and its components on delivered Kt/V (Kt/V-d). Ninete en patients undergoing routine outpatient hemodialysis and receiving IDPN w ere enrolled onto this prospective, crossover study. To reduce the confound ing of time, assigned treatment in the first week was random, with patient crossover in the fourth week. Patients served as their own controls. In the successive 6 weeks, patients received IDPN solutions differing in whether amino acids (AAs), dextrose, or lipids were included or excluded. The prima ry end point was Kt/V-d, measured with a single-pool, variable-volume urea kinetic model. Other factors with the potential to impact an Kt/V-d were co ntrolled and/or monitored. The administration of IDPN with all three compon ents resulted in a significantly reduced mean Kt/V-d. When patients receive d AA-containing solutions, mean Kt/V-d was significantly less than when IDP N was withheld. Administration of solutions without AA resulted in a mean K t/V-d not significantly different from mean Kt/V-d when IDPN was withheld. The mean prescribed KW did not differ from mean Kt/V-d when IDPN was withhe ld. Simulation analyses of increased urea generation (G(u)) showed an incre ase in patient urea volume and decreased KW similar to the study findings. AA-containing IDPN solutions resulted in a significant reduction in Kt/V-d, possibly mediated by increased G(u), Administration of IDPN solutions may have important clinical and economic consequences that warrant further inve stigation. (C) 1999 by the National Kidney Foundation, Inc.