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Intradialytic parenteral nutrition shows some value for malnourished patients, but studies weak
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A review of studies on the use of intradialytic parenteral nutrition shows the therapy has a role in the treatment of protein-energy wasting in malnourished patients on dialysis but has limited value in improving outcomes beyond dietary counseling or oral supplementation for patients with minimal nutritional challenges.
Researchers led by Johanna Anderson, MPH, did a MEDLINE search and used other sources to identify studies released between 2009 and 2018 that dealt with the use of intradialytic parenteral nutrition (IDPN).
“Proponents of IDPN state that it is a safe and convenient way to supplement nutrient intake while patients are already receiving a treatment,” the authors wrote. “Several case series have reported improvements in at least one nutritional indicator after IDPN treatment. However, these studies have inherent bias due to the lack of a concurrent control group.”
Researchers identified 286 potentially relevant studies for review. The mean patient age was 65 years and there was an even distribution of male to female patients. Patients were most often on chronic hemodialysis, with at least 6 months on dialysis.
In their review of results from the studies, the authors wrote, “IDPN did not consistently improve patient health or clinically important nutritional outcomes compared with the standard and recommended treatments of oral supplementation or dietary counseling,” the authors noted. “Compared with usual care, although studies demonstrated some benefits for IDPN, inadequate details about the control group treatment regimen limit the usefulness of this evidence, and the clinical importance of the nutritional improvements is unclear as they were based on changes in mean scores and not clinically relevant thresholds.” Few of the studies addressed adverse effects of IDPN, they said.
The authors said they agreed with existing guidelines that IDPN “is a reasonable treatment option when confronted with patients who fail to respond to or are unable to receive
recommended first-line treatments. Evidence for these first-line treatments is not without limitations. However, owing to the substantially higher cost of IDPN and unknown cost-effectiveness, broad usage of IDPN before these treatment options does not appear warranted.”
Disclosures: The authors report no relevant financial disclosures.
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