Intradialytic parenteral nutrition for patients on hemodialysis: when, how and to whom?
Por:
Carrero, J, Severs, D, Aguilera, D, Fiaccadori, E, Gonzalez, M, Haufe, C, Teta, D, Molina, P and Visser, W
Publicada:
24 ene 2023
Ahead of Print:
1 jul 2022
Resumen:
Lay Summary Hemodialysis for patients with chronic kidney disease is associated with high morbidity and mortality rates as well as low quality of life. Poor nutritional status is an important predictor of these risks, so maintaining optimal nutrition in patients on hemodialysis is a critical but sometimes overlooked aspect of care. Because many patients undergoing hemodialysis cannot maintain good nutrition through daily diet or oral nutritional supplements, intravenous delivery of nutrition during hemodialysis sessions has been proposed as another way to support nutrition over time. In this review, a consensus panel of experienced clinicians reviews the available literature and provides experience-based guidance on when to use this nutritional strategy, which patients may be best suited for this approach, practical strategies for delivery, and how to monitor patients receiving this nutrition during hemodialysis.
Hemodialysis is associated with high morbidity and mortality rates as well as low quality of life. Altered nutritional status and protein-energy wasting are important indicators of these risks. Maintaining optimal nutritional status in patients with hemodialysis is a critical but sometimes overlooked aspect of care. Nutritional support strategies usually begin with dietary counseling and oral nutritional supplements. Patients may not comply with this advice or oral nutritional supplements, however , or compliance may be affected by other complications of progressive chronic kidney disease. Intradialytic parenteral nutrition (IDPN) may be a possibility in these cases, but lack of knowledge on practical aspects of IDPN delivery are seldom discussed and may represent a barrier. In this review, we, as a consensus panel of clinicians experienced with IDPN, survey existing literature and summarize our views on when to use IDPN, which patients may be best suited for IDPN, and how to effectively deliver and monitor this strategy for nutritional support.
Filiaciones:
Carrero, J:
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden
Severs, D:
Erasmus MC, Dept Internal Med, Div Nephrol & Transplantat, Rotterdam, Netherlands
Aguilera, D:
Ctr Hosp Vichy, Vichy, France
Fiaccadori, E:
Parma Univ, Med Sch Hosp, Parma, Italy
Gonzalez, M:
Hosp Univ La Princesa, Madrid, Spain
Haufe, C:
KfH Kidney Ctr, Erfurt, Germany
Teta, D:
Hop Valais, Sion, Switzerland
:
Univ Valencia, Hosp Univ Doctor Peset, Dept Nephrol, FISABIO, Valencia, Spain
Visser, W:
Erasmus MC, Dept Internal Med, Div Dietet, Rotterdam, Netherlands
gold, Green Published
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