Intradialytic parenteral nutrition in patients with moderate-severe malnutrition: a multicentre experience

Authors

  • Concetto Sessa U.O.C. Nefrologia e Dialisi, P.O. “Maggiore” di Modica, Ragusa - Italy https://orcid.org/0000-0002-9144-0647
  • Walter Morale U.O.C. Nefrologia e Dialisi, P.O. “Maggiore” di Modica, Ragusa - Italy
  • Antonino Reina U.O.C. Nefrologia e Dialisi, P.O. S. Marta e S. Venera, Acireale (CT) - Italy
  • Giorgio Battaglia U.O.C. Nefrologia e Dialisi, P.O. S. Marta e S. Venera, Acireale (CT) - Italy
  • Sandra La Rosa U.O. Nefrologia e Dialisi, P.O. “Giovanni Paolo II” Sciacca, Agrigento - Italy
  • Daniela Puliatti U.O.C. Nefrologia, A.O. per l’Emergenza “Cannizzaro”, Catania - Italy
  • Giuseppe Seminara U.O.C. Nefrologia, A.O. per l’Emergenza “Cannizzaro”, Catania - Italy
  • Luca Zanoli Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania - Italy

DOI:

https://doi.org/10.33393/gcnd.2021.2335

Keywords:

Dialysis, Intradialytic parenteral nutrition, Malnutrition, Nutritional supplementation, Protein energy wasting

Abstract

Dialysis patients have a wide range of pathologies that contribute to their frailty. Maintaining a good nutritional status is useful to prevent and treat the so-called Protein-Energy Wasting (PEW), a complex clinical-laboratory condition in which a protein-energy depletion occurs. Adherence to a proper nutritional therapy in CKD requires considerable effort from both patients and health personnel (doctors and nurses). In order to slow down the effects of malnutrition and the disasters that complicate PEW, nephrologists can use supplementation products. In our observational, prospective, multicentre study, we administered an intradialytic parenteral nutrition of a three-compartment emulsion for intravenous infusion through an infusion pump connected to the venous line. After 12 weeks of treatment, subjects with severe malnutrition were reduced from 61.1% to 33.3%, serum creatinine increased by 16% (from 6.00 ± 1.48 mg/dL to 6.98 ± 2.46 mg/dL; P < 0.001), total protein and albumin levels respectively by 13% (from 5.46 ± 0.63 g/dL to 6.19 ± 0.66 g/dL; P < 0.001) and 19% (from 2.70 ± 0.48 g/dL to 3.20 ± 0.57 g/dL; P < 0.001), body weight by 3% (from 55.7 ± 13.2 kg to 57.6 ± 13.0 kg; P < 0.001).

Downloads

Download data is not yet available.

References

Druml W, Kierdorf HP. Parenteral nutrition in patients with renal failure. Guidelines on Parenteral Nutrition, Chapter 17. Ger Med Sc. 2009 Nov 18;7:Doc11. https://doi.org/10.3205/000070 PMID: 20049069

Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391-398. https://doi.org/10.1038/sj.ki.5002585 PMID:18094682 DOI: https://doi.org/10.1038/sj.ki.5002585

Locatelli F, Fouque D, Heimburger O, et al. Nutritional status in dialysis patients: a European consensus.Nephrol Dial Transplant. 2002 Apr e 11917047. 17(4):563-72. https://doi.org/10.1093/ndt/17.4.563 DOI: https://doi.org/10.1093/ndt/17.4.563

Sabatino A, Regolisti G, Antonucci E et al. Intradialytic parenteral nutrition in end-stage renal disease: practical aspects, indications and limits. J Nephrol. 2014 Aug e 24557877., 27(4):377-83. https://doi.org/10.1007/s40620-014-0051-6 DOI: https://doi.org/10.1007/s40620-014-0051-6

Cianciaruso B, Brunori G, Kopple JD, et al. Cross-sectional comparison of malnutrition in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am J Kidney Dis. 1995;26(3):475-486. https://doi.org/10.1016/0272-6386(95)90494-8 PMID:7645556 DOI: https://doi.org/10.1016/0272-6386(95)90494-8

Obi Y, Qader H, Kovesdy CP, Kalantar-Zadeh K. Latest consensus and update on protein-energy wasting in chronic kidney disease. Curr Opin Clin Nutr Metab Care. 2015;18(3):254-262. https://doi.org/10.1097/MCO.0000000000000171 PMID:25807354 DOI: https://doi.org/10.1097/MCO.0000000000000171

Koppe L, Fouque D, Kalantar-Zadeh K. Kidney cachexia or protein-energy wasting in chronic kidney disease: facts and numbers. J Cachexia Sarcopenia Muscle. 2019;10(3):479-484. https://doi.org/10.1002/jcsm.12421, DOI: https://doi.org/10.1002/jcsm.12421

Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116-122. https://doi.org/10.1016/S0899-9007(98)00171-3 PMID:9990575 DOI: https://doi.org/10.1016/S0899-9007(98)00171-3

Cereda E. Mini nutritional assessment. Curr Opin Clin Nutr Metab Care. 2012;15(1):29-41. https://doi.org/10.1097/MCO.0b013e32834d7647 PMID:22037014 DOI: https://doi.org/10.1097/MCO.0b013e32834d7647

GAZZETTA UFFICIALE DELLA REGIONE SICILIANA - PARTE I n. 37; 9-8-2013.

Zouari L, Omri S, Turki S, et al. Quality of life in chronic hemodialysis patients:about 71 cases. Tunis Med. 2016 e 94(1):40-45. PMID: 27525604

Detsky AS, McLaughlin JR Jr, Baker JP, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987;11(1):8-13. https://doi.org/10.1177/014860718701100108 PMID:3820522 DOI: https://doi.org/10.1177/014860718701100108

Daugirdas JT. Rapid methods of estimating Kt/V: three formulas compared. ASAIO Trans. 1990;36(3):M362-M364. PMID:2252700

Farrington K, Davenport A. Would prescribing target Kt dose adjusted for body surface area improve hemodialysis outcomes? Kidney Int. 2016;90(6):1160-1162. https://doi.org/10.1016/j.kint.2016.09.021 PMID:27884309 DOI: https://doi.org/10.1016/j.kint.2016.09.021

Thomas A, Silver SA, Perl J, et al. The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients. Am J Kidney Dis. 2020;75(4):471-479. https://doi.org/10.1053/j.ajkd.2019.08.016 PMID:31732233 DOI: https://doi.org/10.1053/j.ajkd.2019.08.016

Huang CX, Tighiouart H, Beddhu S, et al. Both low muscle mass and low fat are associated with higher all-cause mortality in hemodialysis patients. Kidney Int. 2010 Apr, 20072111, 77(7):624-9. https://doi.org/10.1038/ki.2009.524 DOI: https://doi.org/10.1038/ki.2009.524

. Tattersall J, Martin-Malo A, Pedrini Let al. EBPG guideline on dialysis strategies. Nephrol Dial Transplant. 2007 May e 17507427., 22 Suppl 2:ii5-21. https://doi.org/10.1093/ndt/gfm022 PMID: 17507427 DOI: https://doi.org/10.1093/ndt/gfm022

Stenvinkel P, Heimburger O, Lindholm B. Wasting, but not malnutrition,predicts cardiovascular mortality in end-stage renal disease. Nephrol Dial Transplant 2004 e 2181–2183. https://doi.org/10.1093/ndt/gfh296 DOI: https://doi.org/10.1093/ndt/gfh296

Bozzoli L, Sabatino A, Regolisti G et al. Deplezione proteico-energetica e supplementazione nutrizionale nei pazienti in emodialisi cronica. G Ital Nefrol 2015 e 24, 32 (5). PMID: 26480252

Bossola M, Tazza L, Vulpio C, et al. La malnutrizione nel paziente in emodialisi cronica: prevalenza, patogenesi, terapia. G Ital Nefrol. 2009;26(2):201-214. PMID:19382076

Bossola M, Tazza L, Giungi S et al. Anorexia in hemodialysis patients: an update. G. Kidney Int. 2006 e 70(3):417. https://doi.org/10.1038/sj.ki.5001572 DOI: https://doi.org/10.1038/sj.ki.5001572

Cheung W, Yu PX, Little BM et al. Role of leptin and melanocortin signaling in uremia-associated cachexia. J Clin Invest. 2005 e 115(6):1659. https://doi.org/10.1172/jci22521 PMID: 15931394 DOI: https://doi.org/10.1172/JCI22521

Carrero JJ, Witasp A, Stenvinkel P, et al. Visfatin is increased in chronic kidney disease patients with poor appetite and correlates negatively with fasting serum amino acids and triglyceride levels. Nephrol Dial Transplant. 2010;25(3):901-906. https://doi.org/10.1093/ndt/gfp587 PMID:19948877 DOI: https://doi.org/10.1093/ndt/gfp587

Shi K, Wang F, Jiang H, et al. Gut bacterial translocation may aggravate microinflammation in hemodialysis patients. Dig Dis Sci. 2014 Sep e 15., 59(9):2109-17. Epub 2014 May. https://doi.org/10.1007/s10620-014-3202-7 DOI: https://doi.org/10.1007/s10620-014-3202-7

Dukkipati R, Molnar MZ, Park J, et al. Association of vascular access type with inflammatory marker levels in maintenance hemodialysis patients. Semin Dial. 2014 Jul-Aug e 24118625, 27(4):415-23. https://doi.org/10.1111/sdi.12146 DOI: https://doi.org/10.1111/sdi.12146

Conte F, Righetti M, Limido A. On behalf of the Lombardy patients. Submitted abstract to ERA-EDTA Congress, Amsterdam 2014.

Wolfson M. Use of intradialytic parenteral nutrition in hemodialysis patients. Am J Kidney 1994, e 23(6):856. https://doi.org/10.1016/S0272-6386(12)80140-5 DOI: https://doi.org/10.1016/S0272-6386(12)80140-5

Foulks CJ. An evidence-based evaluation of intradialytic parenteral nutrition. Am J Kidney 1999 e 33(1):186. https://doi.org/10.1016/S0272-6386(99)70281-7 DOI: https://doi.org/10.1016/S0272-6386(99)70281-7

Capelli JP, Kushner H, Camiscioli TC et al. Effect of intradialytic parenteral nutrition on mortality rates in end-stage renal disease care. Am J Kidney Dis. 1994 e 23(6):808. https://doi.org/10.1016/S0272-6386(12)80134-X DOI: https://doi.org/10.1016/S0272-6386(12)80134-X

Abdulan IM, Onofriescu M, Stefaniu R, et al. The predictive value of malnutrition for functional and cognitive status in elderly hemodialysis patients. Int Urol Nephrol. 2019;51(1):155-162. https://doi.org/10.1007/s11255-018-2000-0 PMID:30515732 DOI: https://doi.org/10.1007/s11255-018-2000-0

Kayardi M, Icagasioglu S, Yilmaz A, et al. Serum leptin levels and malnutrition in patients with chronic renal failure. Saudi Med J. 2006 e 27(4):477-481. PMID: 16598323

Muñoz-Pérez E, Espinosa-Cuevas MLÁ, Miranda-Alatriste PV, et al. Combined assessment of nutritional status in patients with peritoneal dialysis using bioelectrical impedance vectors and malnutrition inflammation score. Nutr Hosp. 2017 e 34(5):1125-1132. https://doi.org/10.20960/nh.890. DOI: https://doi.org/10.20960/nh.890

Wang WL, Liang S, Zhu FL, Liu JQ, Chen XM, Cai GY. Association of the malnutrition-inflammation score with anthropometry and body composition measurements in patients with chronic kidney disease. Ann Palliat Med. 2019;8(5):596-603. https://doi.org/10.21037/apm.2019.10.12 PMID:31735045 DOI: https://doi.org/10.21037/apm.2019.10.12

Teixeira Nunes F, de Campos G, Xavier de Paula SM, et al. Dialysis adequacy and nutritional status of hemodialysis patients. Hemodial Int. 2008;12(1):45-51. https://doi.org/10.1111/j.1542-4758.2008.00239.x PMID:18271840 DOI: https://doi.org/10.1111/j.1542-4758.2008.00239.x

Liem YS, Bosch JL, Arends LR et al. Quality of life assessed with the Medical Outcomes Study Short Form 36-Item Health Survey of patients on renal replacement therapy: a systematic review and meta-analysis. Value Health. 2007 e 10(5). https://doi.org/10.1111/j.1524-4733.2007.00193.x PMID: 17888104 DOI: https://doi.org/10.1111/j.1524-4733.2007.00193.x

Published

2021-09-16

How to Cite

Sessa, C., Morale, W., Reina, A., Battaglia, G., La Rosa, S., Puliatti, D., Seminara, G., & Zanoli, L. (2021). Intradialytic parenteral nutrition in patients with moderate-severe malnutrition: a multicentre experience. Giornale Di Clinica Nefrologica E Dialisi, 33(1), 102–111. https://doi.org/10.33393/gcnd.2021.2335

Issue

Section

Original articles

Categories

Received 2021-08-30
Accepted 2021-08-30
Published 2021-09-16

Metrics

Most read articles by the same author(s)