Effect of intradialytic parenteral nutrition on mortality rates in end-stage renal disease care.
Several studies have now demonstrated that low serum albumin and/or low protein catabolic rates correlate with increased risk of death in the chronic hemodialysis patient. A study involving 81 patients receiving thrice-weekly hemodialysis treatments and who had either a low serum albumin and/or protein catabolic rate was conducted to compare the effect of intradialytic parenteral nutrition (IDPN) on mortality rates. Fifty patients received IDPN and 31 patients did not. Thirty-eight of the patients were black (47%), 34 were white (42%), and 9 were Hispanic (11%). The study included 33 diabetic patients (41%), 20 of whom received IDPN. Nondiabetic patients received an average of 725 kcal/hemodialysis treatment and diabetic patients received an average of 670 kcal/hemodialysis treatment. The average length of treatment was 9 months. The results of the study revealed a better survival rate (64% v 52%) for patients treated with IDPN. Using Cox analysis, the IDPN-treated group had a significantly better survival rate (P < 0.01). Serum albumin increased by 12% in the survivors. There was no difference in survival when considered separately for diabetic and nondiabetic patients who received IDPN (mortality rate for diabetics: 50% for treated patients and 54% for untreated patients; mortality rate for nondiabetics: 26% for treated patients and 44% for untreated patients). However, the nondiabetic treated patients had the lowest mortality rates. In conclusion, correction of hypoalbuminemia by IDPN significantly reduced mortality rates overall.
Capelli
J P
JP
Department of Medicine, Our Lady of Lourdes Medical Center, Camden, NJ 08103.
Kushner
H
H
Camiscioli
T C
TC
Chen
S M
SM
Torres
M A
MA
D001835:Body Weight; D003928:Diabetic Nephropathies / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D006435:Renal Dialysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D014508:Urea / Q000378:metabolism
D012709:Serum Albumin; D014508:Urea