The use of intradialytic parenteral nutrition in acuteley ill haemodialysed patients

Background: Protein/caloric malnutrition is a problem in chronically haemodialysed patients, and is an independent risk factor for increased mortality in these patients. Objectives: To assess the safety and efficiency of intradialytic parenteral nutritional (IDPN) as nutritional support in acutely ill haemodialysis patients. Methods: Twenty-two haemodialysis patients received IDPN after either major surgical or medical illnesses. Parameters measured included possible complications of IDPN, dialysis adequacy, patients' weight, protein catabolic rate (PCR) and serum levels of albumin, pre-albumin, creatinine, cholesterol, c-reactive protein (c-RP) and haemoglobin. After the end of the study all patients were followed-up for a further 6 months. Results: Patients received IDPN for 1.5-48 months. Eighteen patients received IDPN < 6 months. IDPN was safe for all patients. Throughout this period dialysis remained adequate. Weight loss in all patients ceased after approximately 2 months of IDPN. PRC, serum albumin, pre-albumin, cholesterol and creatinine levels all increased significantly. c-RP dropped from 77 ± 86 mg/1 to 9 ± 10 mg/ l. Conclusions: IDPN can be safely used in haemodialysed patients who are acutely ill and are unable to meet daily nutritional requirements with an oral intake. All studied parameters of nutrition and inflammation improved significantly while patients were treated with IDPN.