Effects of intradialytic parenteral nutrition in chronic haemodialysis patients with malnutrition: a pilot study.
OBJECTIVE
Protein and calorie malnutrition is frequently observed in chronic haemodialysis (HD) patients. Recently it has been suggested that intradialytic nutritional support with amino acids may improve nutritional status and increase immunocompetence. The aim of this study was to evaluate the effects of intradialytic infusion of amino acids, lipids and glucose on body composition and other parameters of nutritional status in patients undergoing HD.


METHODS
Seven patients with a mean age of 77 +/- 6 years (range, 60-86 years), a mean BMI of 20.1 +/- 2.8 (range, 16.1-24.4) and clinical signs of malnutrition participated in the study (mean time on HD, 51 +/- 36 months). HD was performed 12 hours per week with bicarbonate as a buffer and a polysulfon capillary dialyzer (F-60). During the 3-month period of intervention the patients received an intradialytic parenteral solution during the regular scheduled dialysis treatment, containing amino acids (12 g s/h), a glucose 15% solution (37.5 g/h) and a fat emulsion (12.5 g/h).


RESULTS
(mean +/- SEM) Total calorie intake increased from 1550 +/- 63 to 2255 +/- 114 (kcal/24 h) p < 0.01, during the intervention period and body weight increased from 49.9 +/- 5.9 to 51.9 +/- 5.7 kg (p < 0.005). Fat mass and lean body mass (bioelectrical impedance analysis, BIA) increased from 13.2 +/- 2.6 to 14.2 +/- 2.6 (p < 0.02) and from 36.9 +/- 3.2 to 37.9 +/- 3.2 kg (p < 0.003), respectively. Plasma concentrations of albumin, total protein, transferrin, leptin IGF-I, IGFBP-3 and the protein catabolic rate remained unchanged.


CONCLUSIONS
Supplementary intravenous intradialytic nutrition in chronic HD patients with malnutrition increased total body weight by effecting equivalent increases in lean body and fat masses.
Berneis
K
K
Department of Internal Medicine, University Hospital Liestal, Switzerland.
Iseli-Schaub
J
J
Garbani
E
E
Meier
R
R
Kiss
D
D
D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000008:administration & dosage; D015992:Body Mass Index; D004338:Drug Combinations; D004435:Eating; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D009748:Nutrition Disorders / Q000178:diet therapy* / Q000209:etiology; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods; D010743:Phospholipids / Q000008:administration & dosage; D010865:Pilot Projects; D011506:Proteins / Q000378:metabolism*; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D051437:Renal Insufficiency / Q000150:complications* / Q000378:metabolism; D013012:Sorbitol / Q000008:administration & dosage; D016896:Treatment Outcome; D015431:Weight Loss
D000596:Amino Acids; D004338:Drug Combinations; D005217:Fat Emulsions, Intravenous; D010743:Phospholipids; D011506:Proteins; C008288:Lipofundin; D013012:Sorbitol; D005947:Glucose