Research Abstracts

The Journal of Informed Pharmacotherapy 2002;8:402.

Assessment of Outcomes of Intradialytic Parenteral Nutrition

Nancy Cherry, BSc (Pharm), Karen Shalansky, BSc (Pharm), PharmD, FCSHP

Pharmaceutical Sciences Clinical Service Unit, Vancouver General Hospital, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada.

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 2001. (2001 BC CSHP Research Project Award Winner)


Context

Patients with end-stage renal disease often suffer from malnutrition. One modality used to treat malnourished hemodialysis patients is intradialytic parenteral nutrition (IDPN), a multi-component nutritional supplement. 

Objectives

The primary outcome of this trial was to determine the effects of IDPN on weight and serum albumin in a large tertiary-care institution.

Setting

A 160 bed hospital-based hemodialysis unit.

Design

All patients who received IDPN for greater than 1 month from program inception in June 1997 to December 2000 were analyzed. Patients received IDPN as amino acid 10% 250mL or 500mL, dextrose 50% 250mL and fat emulsion 20% 250mL. IDPN was administered during each hemodialysis run three times weekly. Data was collected at 6 and 3 months prior to IDPN administration as well as at baseline, 3, 6, 9, and 12 months post-therapy. 

Main Outcome Measures

Therapeutic efficacy was assessed by percent change from baseline of dry weight and serum albumin.

Results

Twenty-six courses of IDPN in 24 patients met inclusion criteria. The mean duration of treatment was 4.3 months. A significant decline in dry weight was observed at both 6 and 3 months prior to IDPN initiation. Dry weight increased from baseline and achieved significance at 6, 9 and 12 months post-therapy. Serum albumin also significantly improved from baseline at 3 and 9 months. Compared to baseline, there was a 3 to 5-fold increase in the percent of patients with serum albumin greater than or equal to 34g/L. Adverse drug reactions consisted primarily of excess fluid gain and hyperglycemia.

Conclusions

IDPN significantly increased both weight and serum albumin in malnourished hemodialysis patients.


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