title: Intradialytic parenteral nutrition in malnourished children treated with hemodialysis.
abstract: OBJECTIVE
  To examine the feasibility and effectiveness of intradialytic parenteral nutrition (IDPN) in children on hemodialysis.
  
  
  METHODS
  Prospective experimental study with a single intervention group.
  
  
  METHODS
  A pediatric hemodialysis unit.
  
  
  METHODS
  Four malnourished children on hemodialysis (3 girls and 1 boy) 4 to 18 years of age were studied during a period of 1 year.
  
  
  METHODS
  IDPN, which is composed of amino acids (8.5% solution), glucose (as 10% to 15% dextrose), and 20% fat emulsion, was administered at every dialysis session (3 times a week, during 4 hours each time) for 7 to 12 weeks.
  
  
  METHODS
  Oral caloric intake (evaluated by using a 3-day diet history), dry weight (weight after dialysis), body mass index, percent ideal body weight, total lymphocyte count, and serum levels of albumin before, immediately after cessation of IDPN, and 3 months after cessation of IDPN.
  
  
  RESULTS
  Oral caloric intake increased markedly after IDPN administration, from 5 to 63 kcal/kg/d (mean, 33 kcal/kg/d) before IDPN administration to 35 to 177 kcal/kg/d (mean, 86 kcal/kg/d) at the time of cessation. Weight did not change during the treatment period but it did increase from 9.5 to 36.4 kg (mean, 25 kg) to 11 to 39 kg (mean, 26.7 kg) 3 months later. Percent ideal body weight increased from 73% to 88% (mean, 78.5%) to 79% to 90% (mean, 85.1%), and body mass index increased from 12.2 to 15 kg/m(2) (mean, 13.5 kg/m(2)) to 13.4 to 15.5 kg/m(2) (mean, 14.6 kg/m(2)). Total lymphocyte count increased from 538 to 2,041 cells/mm(3) (mean, 1,403 cells/mm(3)) to 724 to 2,884 cells/mm(3) (mean, 2,066 cells/mm(3)). Plasma levels of albumin increased in 1 patient but remained unchanged in others.
  
  
  CONCLUSIONS
  Short-term IDPN treatment may serve as a safe and effective nutritional intervention in malnourished children on hemodialysis.
authors.affiliation: Nephrology Clinic and Dialysis Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. ikrause@post.tau.ac.il
authors.forename: Irit
authors.initials: I
authors.lastname: Krause
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
authors.forename: Miriam
authors.initials: M
authors.lastname: Davidovits
authors.forename: Sigal
authors.initials: S
authors.lastname: Frishman
authors.forename: Roxana
authors.initials: R
authors.lastname: Cleper
authors.forename: Zahava
authors.initials: Z
authors.lastname: Gamzo
authors.forename: Irit
authors.initials: I
authors.lastname: Poraz
authors.forename: Bella
authors.initials: B
authors.lastname: Eisenstein
mesh_terms: D000293:Adolescent; D015362:Child Nutrition Disorders / Q000209:etiology* / Q000628:therapy; D002675:Child, Preschool; D002149:Energy Intake; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome; D015430:Weight Gain