Effect of intradialytic parenteral nutrition in patients with malnutrition–inflammation complex syndrome on body weight, inflammation, serum lipids and adipocytokines: results from a pilot study

Abstract

Objective: Evaluation of the influence of intradialytic parenteral nutrition (IDPN) in patients suffering from MalnutritionInflammation Complex Syndrome (MICS) on nutritional status, inflammation, adipocytokines and serum lipids. Subjects: Six patients with MICS were assigned to IDPN, whereas six patients matched for age, sex, body mass index (BMI) and co-morbidity without malnutrition served as controls. Patients were recruited from Outpatient Dialysis Unit, Medical University Innsbruck and from Dialysis Unit, Hospital Feldkirch. Results: In all patients with IDPN, dry body weight increased during the interventional period whereas body weight remained stable in patients without IDPN. Tumor necrosis factor (TNF)-a levels were higher in patients with MICS compared with controls at all time points. Total cholesterol, LDL-and HDL-levels significantly increased during dialysis at all time points in controls but not in patients with MICS. Albumin, C-reactive protein, interleukin-6 (IL-6), soluble interleukin-2 receptor (sIL-2R) and adipocytokines did not differ between patients and controls during the study period. Conclusions: IDPN in patients with MICS increases body weight despite not influencing inflammatory status. Furthermore, IDPN does not induce a pro-atherogenic lipid composition enhancing the risk for atherosclerosis. Thus, IDPN is a safe and effective treatment of malnutrition in patients with MICS.

Nutrition Prescription to Achieve Positive Outcomes in Chronic Kidney Disease: A Systematic Review

“…Improvements in overall protein balance improved in a randomized cross over study of 8 patients over 14 days [51] and also in another study which was open labeled and not controlled in 16 patients over 3 months [52]. The use of intradialytic parenteral nutrition (IDPN) solution in HD patients has also only been conducted in small studies, showing improvements in hepatic albumin synthesis and whole body fat free mass [53,54,55,56,57]. In the cross over study of 8 patients using both IDPN and oral supplements, the oral administration resulted in persistent anabolic benefits in the post dialysis phase, which was not seen with IDPN [55].…”

When Is Parenteral Nutrition Appropriate?

“…IDPN refers to PN delivered during the hemodialysis procedure, typically by administering the nutrient admixture through the venous drip chamber of the dialysis circuit 4 . ‐ 7 The majority of the published data include patients with CKD receiving intermittent hemodialysis, although limited data exist for patients on peritoneal dialysis receiving dialysates enriched with amino acids 8 . ‐ 19 IDPN typically provides 500–1000 kcal and 50–100 g of amino acids in less than 1 L of volume per dialysis treatment.…”

“…Published data suggest that IDPN is generally safe and effective in improving nonfluid weight gain over time 8 . ‐ 17 However, these studies generally suffer from a few common limitations: the sample sizes in most reports are small (less than 30 patients); the frequency and intensity of hemodialysis are not described or standardized; and oral nutrient intake is not controlled and often not monitored.…”

Clinical immunology Effect of diet on selected parameters of antioxidative system and inflammatory processes in patients dialyzed due to diabetic kidney disease

“…It turned out that used supplementation caused the increase in BMI but did not significantly affect albumin concentration. Moreover, a decreased TNF-α secretion and slightly increased IL-6 level were observed [25].…”

“…Joannidis et al [25] assessed the effect of 6-month supplementation with nutrient preparations (Aminomel Nephro, Elolipid, L-carnitine and vitamin E) on the nutritional status and inflammatory parameters in patients treated with haemodialysis. It turned out that used supplementation caused the increase in BMI but did not significantly affect albumin concentration.…”