Effectiveness of Intradialytic Parenteral Nutrition in Treating Protein-Energy Wasting in Hemodialysis: A Rapid Systematic Review

Anderson, Johanna; Peterson, Kim; Bourne, Donald; Boundy, Erin

doi:10.1053/j.jrn.2018.11.009

Cited by 22 publications

(29 citation statements)

References 42 publications

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“…The dialysis session is a good opportunity for intravenous administration, useful from the nutritional point of view when food intake is inadequate. A number of studies, in fact, suggest that, in selected patients, intradialytic intravenous nutrition can improve the nutritional status of malnourished dialysis patients in the short-medium term [126][127][128][129][130].…”

Section: Intravenous Formulationsmentioning

confidence: 99%

“…Sugars may aggravate the glucose intolerance encountered in dialysis, and the role of triglycerides, often added as calorie fuel to the intravenous mixture, in worsening atherosclerotic lesions is not clear. Nausea, muscle pain, infections, hyperglycemia, and complications linked to the dialysis procedure have occasionally been reported [126][127][128][129][130][131][132][133][134][135][136]. While baseline dyslipidemia is a contraindication for treatment, no target level based on an evidence-based position has yet been fixed [128].…”

Section: Intravenous Formulationsmentioning

confidence: 99%

“…We therefore suggest that that these supplements can be useful in the short-medium term for patients that, in spite of low food intake, may be able to reverse the metabolic balance from catabolism to anabolism. Naturally, their limits need to be acknowledged, as does our lack of sound evidence in favor of any change in hard outcomes [126][127][128][129]. Furthermore, since the losses are higher in hemodiafiltration, when specific techniques including endogenous reinfusion are not available, the advantages of better depuration of the middle molecules including those involved in inflammation have to be weighed against the use of hemodialysis so that the metabolic advantages, particularly those of amino acid supplementation, are not lost [130,131].…”

Section: Long-term Effectsmentioning

confidence: 99%

“…The low prealbumin level is evidence of low metabolic reactivity and is usually closely linked to the patient's inflammatory status and overall clinical condition. Not surprisingly, in these acute phases, in which the metabolic machine has shut down, intradialytic infusion of amino acids and lipids has little effect on nutritional status [126][127][128][129].…”

Section: Albumin (And Blood Transfusions)mentioning

confidence: 99%

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Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.

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Section: Intravenous Formulationsmentioning

confidence: 99%

Section: Intravenous Formulationsmentioning

confidence: 99%

Section: Long-term Effectsmentioning

confidence: 99%

Section: Albumin (And Blood Transfusions)mentioning

confidence: 99%

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Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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“…When faced with an evident state of malnutrition or PEW, intravenous nutritional and caloric support should be provided. Ideally, this should be administered throughout the entire duration of the extracorporeal session [ 114 , 115 , 116 ]. Parenteral nutrition administration must provide an adequate calorie intake (approx.…”

Section: Nutritional and Therapeutic Interventionsmentioning

confidence: 99%

Hemodialysis—Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses Be the Sharpest “Sword of Damocles”?

Bolasco

2020

Nutrients

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This review aims to highlight the strengths and weaknesses emerging from diagnostic evaluations and prescriptions in an intent to prevent progression over time of malnutrition and/or protein-energy wasting (PEW) in hemodialysis (HD) patients. In particular, indications of the most effective pathway to follow in diagnosing a state of malnutrition are provided based on a range of appropriate chemical-clinical, anthropometric and instrumental analyses and monitoring of the nutritional status of HD patients. Finally, based on the findings of recent studies, therapeutic options to be adopted for the purpose of preventing or slowing down malnutrition have been reviewed, with particular focus on protein-calorie intake, the role of oral and/or intravenous supplements and efficacy of some classes of amino acids. A new determining factor that may lead inexorably to PEW in hemodialysis patients is represented by severe amino acid loss during hemodialysis sessions, for which mandatory compensation should be introduced.

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Continuous intradialytic amino acid infusion from the start of dialysis is better to avoid catabolism under the high-volume pre-dilution on-line HDF

et al. 2022

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Effectiveness of Intradialytic Parenteral Nutrition in Treating Protein-Energy Wasting in Hemodialysis: A Rapid Systematic Review

Cited by 22 publications

References 42 publications

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

Hemodialysis—Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses Be the Sharpest “Sword of Damocles”?

Continuous intradialytic amino acid infusion from the start of dialysis is better to avoid catabolism under the high-volume pre-dilution on-line HDF

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