Could intradialytic nutrition improve refractory anaemia in patients undergoing haemodialysis?

Thabet, Ahmad F.; Moeen, Sawsan M.; Labiqe, Mohammed O.; Saleh, Medhat A.

doi:10.1111/jorc.12206

Cited by 14 publications

(9 citation statements)

References 32 publications

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“…2 ). In agreement with the current study but having lower number of participants, certain earlier randomized trials 19 , 24 showed that serum albumin significantly increased after receiving IDPN when compared with the control arm without IDPN. Previous experimental studies by Pupim and co-workers 25 , 26 also supported these observations by illustrating that nutritional support in the form of IDPN enhanced the fractional synthetic rate of albumin in the liver determined by primed constant stable isotope labeled amino acid infusion and increased whole-body protein synthesis.…”

Section: Discussionsupporting

confidence: 92%

The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial

Kittiskulnam

Banjongjit

Metta

et al. 2022

Sci Rep

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In hemodialysis (HD) patients, protein-energy wasting (PEW) is highly prevalent and firstly treated with oral nutritional supplements (ONS). The extent to which intradialytic parenteral nutrition (IDPN) contributes to improve PEW status in HD patients intolerable to ONS remains unclear. Maintenance PEW HD patients being unable to tolerate ONS adverse effects, and having spontaneous energy and protein intake of ≥ 20 kcal/kg/day and ≥ 0.8 g/kg/day, respectively were randomly assigned 1:1 into IDPN and control groups. In IDPN group, most concentrated 3-in-1, fish-oil based parenteral nutrition was infused during HD for 3 months. The control group received intensive dietary counselling once weekly for 3 months. Both groups were then followed for additional 3 months after intervention. A total of 38 patients were randomized (mean age 67.6 years). After 3 months, serum albumin was significantly higher in the IDPN (n = 18) compared with control group (from 3.5 ± 0.3 to 3.8 ± 0.2 vs from 3.6 ± 0.3 to 3.5 ± 0.3 g/dL, respectively, p = 0.01). Spontaneous dietary intake (p = 0.04), body weight (p = 0.01), and malnutrition inflammation score (MIS, p = 0.01) were improved in the IDPN, but not in the control group. Muscle mass, strength, serum prealbumin, interleukin-6, high sensitivity-c reactive protein, and acylated ghrelin were not significantly different but leptin levels increased in the control group after 3 months (p = 0.03). At 6 months, serum albumin in the IDPN group was persistently higher than baseline (p = 0.04). Neither volume overload nor uncontrolled hyperglycemia was found throughout the study. In conclusion, a 3-month IDPN supplementation demonstrated a significant increase in serum albumin, body weight, spontaneous oral intake, and MIS; and appeared to be superior to continuing intensive dietary counselling among HD patients intolerable to ONS. The impacts of IDPN therapy on clinical outcomes may require larger scale with longer period of study.

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Section: Discussionsupporting

confidence: 92%

The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial

Kittiskulnam

Banjongjit

Metta

et al. 2022

Sci Rep

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“…IDPN is not to be intended as a long‐lasting therapy; in fact, ONS should be restarted and IDPN should be discontinued as soon as possible based on the combination of three of the following criteria: stable serum albumin >3.8 mg/dL for 3 months; improvement in subjective global assessment (SGA) score to A (well‐nourished) or B (moderately malnourished); clinical examination of improved nutritional status; increase in protein and energy oral intake to >1.0 g/kg/d and to >30 kcal/kg/d . Despite the lack of studies demonstrating any benefit of IDPN on mortality, there is convincing evidence about its positive effects on nitrogen balance, anthropometric parameters and serum prealbumin, a surrogate parameter for hard outcomes in malnourished hemodialysis patients . Such early benefits of IDPN can be identified as soon as after 1 month of treatment when prealbumin is monitored .…”

Section: Nutritional Needs In Esrd Patientsmentioning

confidence: 99%

“…Such early benefits of IDPN can be identified as soon as after 1 month of treatment when prealbumin is monitored . A recent but small, randomized, controlled trial designed to evaluate the efficacy of IDPN therapy in malnourished patients with refractory anemia suggested an improvement in nutritional status assessed by the malnutrition inflammation score (MIS), BMI and albumin, as well as an improvement in refractory anemia . Despite its possible risks that must be take into consideration (Figure ), IDPN seems to be metabolically safe …”

Section: Nutritional Needs In Esrd Patientsmentioning

confidence: 99%

Dietary protein and nutritional supplements in conventional hemodialysis

Sabatino

Piotti

Cosola

et al. 2018

Seminars in Dialysis

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Protein energy wasting (PEW) is a condition commonly occurring among patients with ESRD on hemodialysis. PEW is characterized by depletion of protein and energy stores and is caused by multiple factors related to chronic kidney disease, acute and chronic comorbidities and by renal replacement therapy itself. Anorexia is central in the pathogenesis of PEW; it is frequently observed in these patients whose protein and energy intakes are typically lower than guidelines recommendations. If untreated, PEW invariably leads to major complications, and may activate a vicious circle with further worsening of nutritional status. Dietary counseling and nutritional status monitoring play a key role in the prevention and treatment of PEW, since they allow an early identification of high risk patients, as well as the assessment of the response to nutritional intervention. Different nutritional approaches can be implemented following thorough nutritional counseling. These are chosen on the basis of patients' spontaneous dietary intake, severity of PEW and acute comorbidities. Initially, regular encounters with the dietitian allow patients to clarify doubts and strengthen basic concepts on nutrition to improve dietary intake and prevent PEW. When PEW is present or the patient is at high risk, the clinician may opt for the administration of oral intradialytic or daily supplements, aiming at increasing energy and protein intake, while in selected cases intradialytic parenteral nutrition may be used. This review addresses the main issues of nutritional status in ESRD patients on hemodialysis-its evaluation and monitoring, as well as at describing the available nutritional interventions.

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“…Anaemia is also an issue for patients with CKD and is one of the factors which impinges significantly on quality of life and cardiovascular complications. Managing iron status during dialysis has been shown to reduce inflammation, which will improve other clinical outcomes .…”

Section: Nutritional Status and Clinical Outcomesmentioning

confidence: 99%

The challenge of nutritional management in people with kidney disease

Langley‐Evans

Thomas

2017

J Human Nutrition Diet

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Could intradialytic nutrition improve refractory anaemia in patients undergoing haemodialysis?

Abstract: IDPN has a good role in improving refractory anaemia by significantly increasing haemoglobin levels, body weight, and serum albumin levels. The intervention also significantly decreases the MIS of patients.

Cited by 14 publications

References 32 publications

The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial

The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial

Dietary protein and nutritional supplements in conventional hemodialysis

The challenge of nutritional management in people with kidney disease

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