Intradialytic parenteral nutrition in malnourished patients on chronic haemodialysis therapy.
BACKGROUND
Malnutrition is frequently encountered in patients on regular haemodialysis therapy and presents an important determinant of morbidity and mortality. Usual therapeutic approaches to alleviate malnutrition have been unsuccessful. The objective of this study was to assess the impact of intradialytic parenteral nutrition (IDPN) with amino acids (in combination with a glucose-containing dialysate) on nutritional parameters and immunocompetence in patients on regular haemodialysis treatment.


METHODS
Effects of IDPN were evaluated in 16 malnourished patients. After a run-in period of 4 weeks (to define stable baseline conditions) 0.8 g amino acids/kg bodyweight using a novel amino-acid solution (adapted to metabolic alteration of uraemia and including the dipeptide glycyl-tyrosine as tyrosine source) was infused thrice weekly during each haemodialysis session for 16 weeks.


RESULTS
Intradialytic amino-acid infusion was well tolerated and the dipeptide was rapidly utilized with only traces being detectable in plasma after dialysis. Visceral protein synthesis was improved, serum albumin, prealbumin, and cholinesterase increased during IDPN (P < 0.05). As indicators of augmented immunocompetence skin test reactivity against multiple antigens was improved (P < 0.02) and total lymphocyte count was raised (P < 0.05). Plasma amino acid pattern did not deteriorate but failed to normalize during IDPN and phenylalanine/tyrosine ratio remained stable. Anthropometric measurements and eating behaviour as assessed by dietary records were not altered during IDPN.


CONCLUSIONS
Even using a simple and limited intradialytic nutritional support with amino acids can improve visceral protein status and stimulate immunocompetence in malnourished patients on regular haemodialysis therapy.
Medical Department, University of Graz, Austria.
K H
KH
Smolle
P
P
Kaufmann
H
H
Holzer
W
W
Druml
D000596:Amino Acids / Q000627:therapeutic use; D001798:Blood Proteins / Q000378:metabolism; D001835:Body Weight; D003131:Combined Modality Therapy; D015314:Dialysis Solutions / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D010288:Parenteral Nutrition; D006435:Renal Dialysis; D014511:Uremia / Q000150:complications / Q000378:metabolism / Q000628:therapy*
D000596:Amino Acids; D001798:Blood Proteins; D015314:Dialysis Solutions