학술논문
Intradialytic parenteral nutrition for patients on hemodialysis: when, how and to whom?
Document Type
Academic Journal
Author
Source
Clinical Kidney Journal. January 2023, Vol. 16 Issue 1, p5, 14 p.
Subject
Language
English
ISSN
2048-8505
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with high morbidity and mortality rates as well as low quality of life (QOL), with nutritional status being an important indicator of these [...]
Hemodialysis is associated with high morbidity and mortality rates as well as low quality of life. Altered nutritional status and protein-energy wasting are important indicators of these risks. Maintaining optimal nutritional status in patients with hemodialysis is a critical but sometimes overlooked aspect of care. Nutritional support strategies usually begin with dietary counseling and oral nutritional supplements. Patients may not comply with this advice or oral nutritional supplements, however, or compliance may be affected by other complications of progressive chronic kidney disease. Intradialytic parenteral nutrition (IDPN) may be a possibility in these cases, but lack of knowledge on practical aspects of IDPN delivery are seldom discussed and may represent a barrier. In this review, we, as a consensus panel of clinicians experienced with IDPN, survey existing literature and summarize our views on when to use IDPN, which patients may be best suited for IDPN, and how to effectively deliver and monitor this strategy for nutritional support. Hemodialysis for patients with chronic kidney disease is associated with high morbidity and mortality rates as well as low quality of life. Poor nutritional status is an important predictor of these risks, so maintaining optimal nutrition in patients on hemodialysis is a critical but sometimes overlooked aspect of care. Because many patients undergoing hemodialysis cannot maintain good nutrition through daily diet or oral nutritional supplements, intravenous delivery of nutrition during hemodialysis sessions has been proposed as another way to support nutrition over time. In this review, a consensus panel of experienced clinicians reviews the available literature and provides experience-based guidance on when to use this nutritional strategy, which patients may be best suited for this approach, practical strategies for delivery, and how to monitor patients receiving this nutrition during hemodialysis. Keywords: chronic kidney disease, hemodialysis, parenteral nutrition, protein-energy malnutrition
Hemodialysis is associated with high morbidity and mortality rates as well as low quality of life. Altered nutritional status and protein-energy wasting are important indicators of these risks. Maintaining optimal nutritional status in patients with hemodialysis is a critical but sometimes overlooked aspect of care. Nutritional support strategies usually begin with dietary counseling and oral nutritional supplements. Patients may not comply with this advice or oral nutritional supplements, however, or compliance may be affected by other complications of progressive chronic kidney disease. Intradialytic parenteral nutrition (IDPN) may be a possibility in these cases, but lack of knowledge on practical aspects of IDPN delivery are seldom discussed and may represent a barrier. In this review, we, as a consensus panel of clinicians experienced with IDPN, survey existing literature and summarize our views on when to use IDPN, which patients may be best suited for IDPN, and how to effectively deliver and monitor this strategy for nutritional support. Hemodialysis for patients with chronic kidney disease is associated with high morbidity and mortality rates as well as low quality of life. Poor nutritional status is an important predictor of these risks, so maintaining optimal nutrition in patients on hemodialysis is a critical but sometimes overlooked aspect of care. Because many patients undergoing hemodialysis cannot maintain good nutrition through daily diet or oral nutritional supplements, intravenous delivery of nutrition during hemodialysis sessions has been proposed as another way to support nutrition over time. In this review, a consensus panel of experienced clinicians reviews the available literature and provides experience-based guidance on when to use this nutritional strategy, which patients may be best suited for this approach, practical strategies for delivery, and how to monitor patients receiving this nutrition during hemodialysis. Keywords: chronic kidney disease, hemodialysis, parenteral nutrition, protein-energy malnutrition