Renal Nutrition Therapy & Services

Clinical Studies

Clinical Studies on IDPN and IPN

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.

Intradialytic Parenteral Nutrition References

Potential impact of nutritional intervention on end-stage renal disease hospitalization, death, and treatment costs. Lacson E et al. 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. Results showed decreased mortality, reduced treatment costs, and decreased hospitalization.

Severity of hypoalbuminemia predicts response to intradialytic parenteral nutrition in hemodialysis patients. Dezfuli A et al. 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. Patients with lower albumin levels and diabetics respond the most dramatically.

The Use Of Intradialytic Parenteral nutrition In Acutely Ill Haemodialysed Patients. Korzets A et al. Journal of Renal Care, 34: 14–18. doi:10.1111/j.1755-6686.2008.00005.x

Summary: All studied parameters of nutrition and inflammation improved significantly while patients were treated with IDPN. Results included 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 and 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). Marsen T.A. et al. Clinical Nutrition Supplements, Volume 7, Issue 1, Page 15.

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 107 malnourished HD patients and showed a 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 6 week 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. IDPN promoted a 96% increase in whole-body protein synthesis, 50% decrease in whole-body proteolysis, and 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 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-based peritoneal dialysis solution improves amino-acid transport into skeletal muscle. Asola, M et al. Kidney Int Suppl. 2008 Apr;(108):S131-6. doi: 10.1038/sj.ki.5002614

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.

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

Summary: 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.

Intradialytic Parenteral Nutrition and Intraperitoneal Nutrition, M. Patricia Fuhrman. Nutrition in Clinical Practice 2009; 24:470

Summary: IDPN and IPN should be considered when attempts to meet nutrient needs by oral diet or tube feeding have not been successful. IDPN and IPN are supplemental nutrition therapies that, when combined with oral diet and tube feeding, enable the patient to meet energy and nutrient needs and improve nutrition status.