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The use of intradialytic parenteral nutrition to treat malnutrition: a case study.

Abstract

Protein energy malnutrition in dialysis patients has been well-described in the literature. Most malnourished patients with end stage renal disease (ESRD) suffer from a mixed marasmus-kwashiorkor type of malnutrition with loss of both somatic and visceral protein mass. Malnutrition is associated with increased risk of morbidity and mortality. Up to 50% of patients on dialysis have protein energy malnutrition (Mortelmans & Vanholder, 1999). Malnutrition may be under-recognized and under-reported in dialysis patients. Malnutrition may result from inadequate food intake secondary to the uremic condition, nausea, vomiting, loss of appetite, altered taste and other physiologic conditions that impede food intake or metabolism. The usual indices of nutritional assessment--body weight, body mass index (BMI), anthropometrics, etc., may be inaccurate in patients with ESRD, as the results are often skewed by fluid retention. Therefore, we often rely on weight loss, bloodwork, a pre-dialysis low serum potassium, phosphorus and urea, as early signs of a decreased food intake. When patients are malnourished, measures such as oral supplements and/or tube feedings may be used to augment protein and calorie intake. However, when these interventions are inadequate to reverse the malnutrition condition, intradialytic parenteral nutrition (IDPN) should be implemented. Although there is no definite supportive data to show that the use of IDPN improves morbidity and mortality of dialysis patients, there are data to support that IDPN has positive effects on numerous nutritional parameters (Acchiardo, 2000; Capelli et al., 1994; Foulks, 1999; Hiroshige et al., 1998; Ikizler et al., 1995; Korzets et al., 1999; Mortelmans & Vanholder, 1999; Saunders et al., 1999; Smolle et al., 1995). In this article, we will discuss the causes of malnutrition in dialysis patients, the use of IDPN on one of our patients, and the potential complications associated with IDPN.

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  • Authors+Show Affiliations

    ,

    In-Centre Hemodialysis Unit, Capital Health, Queen Elizabeth II, Health Sciences Centre, Halifax NS. petula.wong@cdha.nshealth.ca

    ,

    Source

    CANNT journal = Journal ACITN 13:2 pg 31-46; quiz 37-9,46-8

    MeSH

    Body Weight
    Female
    Humans
    Kidney Failure, Chronic
    Middle Aged
    Nutrition Assessment
    Nutritional Requirements
    Parenteral Nutrition, Total
    Patient Care Planning
    Patient Selection
    Protein-Energy Malnutrition
    Renal Dialysis
    Risk Factors
    Serum Albumin

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng fre

    PubMed ID

    14535227

    Citation

    Wong, Petula, et al. "The Use of Intradialytic Parenteral Nutrition to Treat Malnutrition: a Case Study." CANNT Journal = Journal ACITN, vol. 13, no. 2, 2003, pp. 31-46; quiz 37-9,46-8.
    Wong P, Smith P, Rodger D. The use of intradialytic parenteral nutrition to treat malnutrition: a case study. CANNT J. 2003;13(2):31-46; quiz 37-9,46-8.
    Wong, P., Smith, P., & Rodger, D. (2003). The use of intradialytic parenteral nutrition to treat malnutrition: a case study. CANNT Journal = Journal ACITN, 13(2), pp. 31-46; quiz 37-9,46-8.
    Wong P, Smith P, Rodger D. The Use of Intradialytic Parenteral Nutrition to Treat Malnutrition: a Case Study. CANNT J. 2003;13(2):31-46; quiz 37-9,46-8. PubMed PMID: 14535227.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The use of intradialytic parenteral nutrition to treat malnutrition: a case study. AU - Wong,Petula, AU - Smith,Pamela, AU - Rodger,Diane, PY - 2003/10/11/pubmed PY - 2003/12/3/medline PY - 2003/10/11/entrez SP - 31-46; quiz 37-9,46-8 JF - CANNT journal = Journal ACITN JO - CANNT J VL - 13 IS - 2 N2 - Protein energy malnutrition in dialysis patients has been well-described in the literature. Most malnourished patients with end stage renal disease (ESRD) suffer from a mixed marasmus-kwashiorkor type of malnutrition with loss of both somatic and visceral protein mass. Malnutrition is associated with increased risk of morbidity and mortality. Up to 50% of patients on dialysis have protein energy malnutrition (Mortelmans & Vanholder, 1999). Malnutrition may be under-recognized and under-reported in dialysis patients. Malnutrition may result from inadequate food intake secondary to the uremic condition, nausea, vomiting, loss of appetite, altered taste and other physiologic conditions that impede food intake or metabolism. The usual indices of nutritional assessment--body weight, body mass index (BMI), anthropometrics, etc., may be inaccurate in patients with ESRD, as the results are often skewed by fluid retention. Therefore, we often rely on weight loss, bloodwork, a pre-dialysis low serum potassium, phosphorus and urea, as early signs of a decreased food intake. When patients are malnourished, measures such as oral supplements and/or tube feedings may be used to augment protein and calorie intake. However, when these interventions are inadequate to reverse the malnutrition condition, intradialytic parenteral nutrition (IDPN) should be implemented. Although there is no definite supportive data to show that the use of IDPN improves morbidity and mortality of dialysis patients, there are data to support that IDPN has positive effects on numerous nutritional parameters (Acchiardo, 2000; Capelli et al., 1994; Foulks, 1999; Hiroshige et al., 1998; Ikizler et al., 1995; Korzets et al., 1999; Mortelmans & Vanholder, 1999; Saunders et al., 1999; Smolle et al., 1995). In this article, we will discuss the causes of malnutrition in dialysis patients, the use of IDPN on one of our patients, and the potential complications associated with IDPN. SN - 1498-5136 UR - https://www.unboundmedicine.com/medline/citation/14535227/The_use_of_intradialytic_parenteral_nutrition_to_treat_malnutrition:_a_case_study_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=14535227.ui DB - PRIME DP - Unbound Medicine ER -