Renal Nutrition Therapy & Services

Clinical Studies

Therapies/Clinical Studies

The following clinical studies and meta analysis support the effectiveness and positive outcomes of using Intradialytic Parenteral Nutrition (IDPN) and Intraperitoneal Nutrition (IPN) when appropriate in dialysis patients. All referenced studies below are available on the internet through any search engine if a complete review of the study is desired. Patient Care America branded product line of IDPN and IPN is NutriRite™ Protein Infusion Therapy.

Intradialytic Parenteral Nutrition References

Potential impact of nutritional intervention on end-stage renal disease hospitalization, death, and treatment costs Lacson E, Ikizler A, Lazarus M, Teng M, Hakim RM. – Journal of Renal Nutrition 2007, 17:363-371

Summary: In this hypothetical scenario, increasing the albumin by 0.2 g/dL had the potential to save 1400 lives, avert 6000 hospitalizations, and save $36 million Medicare dollars

Outcome: Decreased Mortality, Reduced Treatment Costs, Decreased Hospitalization

Severity of hypoalbuminemia predicts response to intradialytic parenteral nutrition in hemodialysis patients. Dezfuli A, Scholl D, Lindenfeld SM, Kovesdy CP, Kalantar- Zadeh K. Journal of Renal Nutrition 2009, 19:291-297

Summary: Patients with a serum albumin < 3 g/dL at baseline had a 2.5 times higher chance of increasing the albumin and a 3.8 times higher chance of increasing the albumin by at least 0.5 g/dL.

Outcome: Patients with lower albumin levels and diabetics respond the most dramatically

The Use Of Intradialytic Parenteral nutrition In Acutely Ill Haemodialysed Patients, Journal Of Renal Care 34(1), 14-18, 2008 Korzets A., Azoulay O., Ori Y., Zevin D., Boaz M., Herman M., Chagnac A., Gafter U,

Summary: All studied parameters of nutrition and inflammation improved significantly while patients were treated with IDPN.

Outcome: Increase in Protein catabolic rate (g protein/kg/day) 0.7 ± 0.2 to 1.2 ± 0.2, Increase in Albumin (g/l) 28 ± 5 to 38 ± 2, Decrease c-RP (mg/l) 77 ± 86 to 9 ±10

Intradialytic parenteral nutrition (IDPN) leads to sustained increase of serum prealbumin (PA) levels in malnourished hemodialysis (HD) T.A. Marsen, S. Degenhardt, C. Hoffmann, H. Mann.

Summary: PreAlbumin is a nutritional parameter, positively correlated with reduced morbidity and survival in malnourished HD patients. The study addressed changes of PA during 16 weeks of IDPN in malnourished HD patients. 107 malnourished HD patients albumin

Outcome: Significant increase of PreAlbumin (SG: +26.31 mg/l vs CG: 1.84 mg/l), Diabetic patients revealed higher increase of PreAlbumin (SG: +32.62 mg/l vs CG: 1.67 mg/l), PreAlbumin elevation was maintained during 6w follow-up period

Nutrition support for the chronically wasted or acutely catabolic chronic kidney disease patient. Ikizler TA Seminar of Nephrology. 2009, 29:75-84. [Meta-analysis]

Summary: Available evidence suggests that nutritional supplementation, administered orally or parenteral, is effective in the treatment of maintenance dialysis patients with protein-energy wasting in whom oral dietary intake from regular meals cannot maintain adequate nutritional stores. Increase serum albumin by 0.2 g/dL or greater considerable improvements in mortality, Hospitalization, and treatment costs.

Outcome: IDPN promoted a 96% increase in whole-body protein synthesis, 50% decrease in whole body proteolysis, Positive Nitrogen

Intraperitoneal Nutrition References

Peritoneal dialysis with solutions containing amino acids plus glucose promotes protein synthesis during oral feeding. Tjiong HL et al. Clinical Journal American Society of Nephrology. 2007, 2:74-80

Summary: Using Amino Acid based dialysate with dextrose, as compared with the control, resulted in rates of protein synthesis increasing significantly.

New insight of amino acid-based dialysis solutions. Park MS, Choi SR, et.al; Kidney International (2006) 70, S110–S114. doi:10.1038/sj.ki.5001925

Summary: 31/43 malnourished PD patients (72%) showed nutritional benefit using IPN in terms of improvement of lean body mass, hand grip strength and back lift strength which were significantly higher in responders at baseline.

Acute effects of peritoneal dialysis with dialysates containing dextrose or dextrose and amino acids on muscle protein turnover in patients with chronic renal failure. Garibotto G et al. Journal of American Society of Nephrology. 2001, 12:557-567.

Summary: Dextrose alone resulted in increased insulin levels, decreased amino acid levels, and a persistent negative protein balance. The combined use of amino acids and dextrose resulted in a cumulative effect of suppressing muscle amino acid losses and stimulating muscle protein synthesis.

Amino-acid transport with amino-acid dialysis solution. M Asola et al.: Kidney International (2008), Finland.

Summary: Glucose-based PD solutions, only one daily bag of amino acid solution, showed increased plasma Amino Acid concentrations, skeletal muscle Amino Acid uptake was significantly higher during treatment containing Amino Acid solution.

M Jones et al. Treatment of malnutrition with 1.1% amino acid peritoneal dialysis solution: results of a multicenter outpatient study. American Journal of Kidney Disorders. 1998 Nov, 32(5):761-9.

Amino Acid based dialysate had significant decreases in serum potassium and phosphorus indicating a general anabolic response for patients. Prealbumin and transferrin levels were significantly increased. Patients with regular dextrose based formulation had decreases in albumin, prealbumin, and total protein levels.

M. Patricia Fuhrman, Intradialytic Parenteral Nutrition and Intraperitoneal Nutrition, Nutrition in Clinical Practice 2009; 24:470. Full article at: SAGE Journals