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Molina P, Quilis A, Durbá A, Barril G, Pérez-Torres A, Sánchez-Villanueva R, Huarte E, González-Oliva JC, Cigarrán S, Prieto-Velasco M, García-Falcón T, Salgueira M, Gaínza FJ, Carrero JJ. A roadmap for implementing a successful clinical experience with intradialytic parenteral nutrition. Clin Nutr ESPEN 2024; 63:322-331. [PMID: 38976478 DOI: 10.1016/j.clnesp.2024.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND AND AIMS Intradialytic parenteral nutrition (IDPN) is a safe and effective patient-tailored nutritional strategy for providing nutrient supplementation to malnourished or at risk of malnutrition patients on hemodialysis (HD), who did not adequately respond to intensive dietary counselling and oral nutritional supplementation. Although IDPN is recommended by current ESPEN and KDOQI guidelines for nutrition in HD patients, none of these documents informs how to successfully implement this therapy, being the lack of knowledge on practical aspects of IDPN one of the main limitations to its use. The aim of this narrative review was to provide a practical roadmap for guiding the nephrologists, dietitians, and renal nurses in their everyday clinical practice about the use of IDPN. METHODS A multidisciplinary group formed by specialists from the areas of Nephrology and Nutrition agreed to address different practical aspects related to IDPN in HD patients. Based on the available evidence in the literature and on the authors' clinical experience, different topics were selected to develop a detailed plan for implementing a successful experience with IDPN, proposing a practical IDPN roadmap. RESULTS This IDPN roadmap provides practical information on when an IDPN should be started; what type of nutrients should be part of an IDPN; how the IDPN should be administered; how the effectiveness and safety of the IDPN should be monitored; how to determine the effectiveness of IDPN; and the conditions that advise discontinuing the IDPN. CONCLUSIONS IDPN is a safe and effective nutritional therapy for HD patients, although the lack of staff training may limit its use. This review addresses different practical aspects of IDPN, helping interdisciplinary teams in their daily clinical practice to improve the nutritional care of HD patients, either malnourished or at risk of malnutrition.
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Affiliation(s)
- Pablo Molina
- Department of Nephrology, FISABIO, Hospital Universitari Doctor Peset, Valencia, Spain; Department of Medicine, Universitat de València, Spain; Multidisciplinary Renal Nutrition Working Group, Spanish Society of Nephrology, Spain.
| | - Aina Quilis
- Department of Nephrology, FISABIO, Hospital Universitari Doctor Peset, Valencia, Spain
| | - Alba Durbá
- Department of Nephrology, FISABIO, Hospital Universitari Doctor Peset, Valencia, Spain; Multidisciplinary Renal Nutrition Working Group, Spanish Society of Nephrology, Spain
| | - Guillermina Barril
- Multidisciplinary Renal Nutrition Working Group, Spanish Society of Nephrology, Spain; Biomedical Research Foundation, Hospital Universitario de La Princesa, Madrid, Spain
| | - Almudena Pérez-Torres
- Multidisciplinary Renal Nutrition Working Group, Spanish Society of Nephrology, Spain; Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain; Department of Nutrition, Hospital Universitario Santa Cristina, Madrid, Spain
| | | | - Emma Huarte
- Department of Nephrology, Hospital de San Pedro, Logroño, Spain
| | - Juan Carlos González-Oliva
- Department of Nephrology, Hospital de Mollet, Fundació Sanitària Mollet, Mollet del Vallès, Barcelona, Spain
| | - Secundino Cigarrán
- Multidisciplinary Renal Nutrition Working Group, Spanish Society of Nephrology, Spain; Department of Nephrology, Hospital Ribera Polusa, Lugo, Spain
| | | | - Teresa García-Falcón
- Department of Nephrology, Complexo Hospitalario Universitario A, Coruña, A Coruña, Spain
| | - Mercedes Salgueira
- Department of Nephrology, Hospital Universitario Virgen Macarena, Department of Medicine at University of Seville, Spain
| | - Franciso Javier Gaínza
- Department of Nephrology, Hospital Universitario de Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Juan Jesús Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Allawi AAD. Malnutrition, inflamation and atherosclerosis (MIA syndrome) in patients with end stage renal disease on maintenance hemodialysis (a single centre experience). Diabetes Metab Syndr 2018; 12:91-97. [PMID: 28964721 DOI: 10.1016/j.dsx.2017.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Inflammation and malnutrition play an important role in endothelial dysfunction, atherosclerosis and excessive cardiovascular morbidity and mortality in ESRD patients AIM OF THE STUDY: The primary objective is to determine the prevalence of inflammation, malnutrition and atherosclerosis in patients on maintenance haemodialysis. Secondary objective was to determine the association for atherosclerosis with inflammation and malnutrition. PATIENT AND METHODS One hundred and one adult patients with end stage renal disease on maintenance haemodialysis who are met with the exclusion criteria were enrolled in this cross sectional study from haemodialysis unit of Baghdad teaching hospital over the period of July/2015 - June 2016. All patients were thoroughly examined and many variables were evaluated (age, gender, blood pressure, diabetes mellitus, serum lipid profile, smoking habits, serum albumin, CRP, calcium, Phosphate, Parathyroid hormone and haemoglobin measurements). All patients underwent a carotid Doppler ultrasound study. RESULTS Atherosclerosis was present in 65.3%: 58.4% of patients had malnutrition and 43.6% had inflammation. The association for atherosclerosis and high CRP and low serum albumin is strong and independent of other atherosclerosis risk factors. There is significant inverse and independent correlation between CRP and albumin. CONCLUSION Inflammation (high serum CRP) and malnutrition (low serum albumin) in patients on haemodialysis are significantly associated with carotid atherosclerosis. Inflammation was more prevalent in the malnourished patients than in those with normal nutritional status.
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Affiliation(s)
- Ali Abdulmajid Dyab Allawi
- FRCP London, Assistant Professor Baghdad College of Medicine, University of Baghdad, Consultant Nephrologist and Transplant Physcian, Baghdad, Iraq.
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