S BAHCECI1, M CHAN1
1St George Hospital , Sydney, Australia
Aim: To examine the effectiveness of supplemental Intradialytic Parenteral Nutrition (IDPN) on nutritional outcomes of malnourished haemodialysis (HD) patients.
Background: IDPN has been demonstrated in the literature to be a feasible mode of nutrition support; however it is not commonly used for malnourished HD patients in Australia.
Methods: Three malnourished patients identified using the subjective global assessment (SGA B-C) at a tertiary facility HD unit who did not respond to conventional nutrition support commenced supplemental IDPN. These patients also continued to receive concurrent nutrition support including oral nutrition supplementation and dietary counselling by the dietitian. These patients received the standard IDPN formula of electrolyte free amino acids and lipids as per the hospital dietetic protocol providing a total of 1000ml IDPN, 1213kcal, 53g protein, 100g fat, 0g carbohydrates each dialysis session three times per week. The patients’ nutritional parameters including anthropometry, biochemistry, oral intake and nutritional status were monitored over a ten week period.
Results: All three patients responded to nutrition support with supplemental IDPN and improved their nutritional status over the 10 week period. All patients on average improved their nutritional parameters, including total dry body weight (5%) total caloric intake (63%), oral caloric intake (16%), albumin (13%), and hand grip strength (4%). All three patients reported markedly improved levels of energy and stimulation of appetite. Nil adverse events were reported.
Conclusions: IDPN was found to be a safe and effective mode of nutrition support for malnourished HD patients. These observations may pave way for the wider acceptance of such use in Australia.
Su Bahceci is a clinical dietitian working at St George Hospital, Sydney with extensive experience in a number of medical and surgical clinical areas and has been specialising for over four years in the renal acute inpatient and chronic outpatient settings. She has undertaken post-graduate training in renal nutrition. Su has a vested interest in research, particularly in nutrition support for malnourished renal patients and examining the role of intradialytic parenteral nutrition on nutritional outcomes. She is also enthusiastic about mentoring fellow dietitians and students in the area of renal nutrition.