Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study.
Although intradialytic parenteral nutrition (IDPN) is a method used widely to combat protein-calorie malnutrition in hemodialysis patients, its effect on survival has not been thoroughly studied. We conducted a prospective, randomized trial in which 186 malnourished hemodialysis patients received oral nutritional supplements with or without 1 year of IDPN. IDPN did not improve 2-year mortality (primary end point), hospitalization rate, Karnofsky score, body mass index, or laboratory markers of nutritional status. Instead, both groups demonstrated improvement in body mass index and the nutritional parameters serum albumin and prealbumin (P < 0.05). Multivariate analysis showed that an increase in prealbumin of >30 mg/L within 3 months, a marker of nutritional improvement, independently predicted a 54% decrease in 2-year mortality, as well as reduced hospitalizations and improved general well-being as measured by the Karnofsky score. Therefore, although we found no definite advantage of adding IDPN to oral nutritional supplementation, this is the first prospective study demonstrating that an improvement in prealbumin during nutritional therapy is associated with a decrease in morbidity and mortality in malnourished hemodialysis patients.
Cano
Noël J M
NJ
Service d'Hépatogastroenterologie et Nutrition, Clinique Résidence du Parc, Marseille, France. ncano@clermont.inra.fr
Fouque
Denis
D
Roth
Hubert
H
Aparicio
Michel
M
Azar
Raymond
R
Canaud
Bernard
B
Chauveau
Philippe
P
Combe
Christian
C
Laville
Maurice
M
Leverve
Xavier M
XM
D000368:Aged; D015992:Body Mass Index; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017567:Karnofsky Performance Status; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011228:Prealbumin / Q000378:metabolism; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects*; D012709:Serum Albumin / Q000378:metabolism; D016019:Survival Analysis
D011228:Prealbumin; D012709:Serum Albumin