Malnutrition is a common problem that is associated with unfavourable clinical progression, more frequent hospitalisation, and increased mortality in patients on dialysis. For dialysis patients with diabetes mellitus (DM) or tumour patients, the risk is especially high. In order to improve nutritional status, different therapeutic approaches are followed; intradialytic parenteral nutritional therapy (IDPN) is one of them. We herein compared the effects of IDPN on protein metabolism, BMI, and phase angle in dialysis patients with DM or tumour disease to patients without DM or malignancy.
We analysed single-centre data from 57 chronic haemodialysis patients with malnutrition (17 with DM, 20 with malignancy), who were treated with IDPN for ≥6 months between January 2013 and December 2015. An individualised IDPN infusion regime containing 800–1,000 kcal per application was administered three-times a week. Assessments of laboratory parameters, phase angle, and BMI were performed every 3 months. In contrast to tumour patients with a low BMI (22.2±7.0), patients with DM showed a normal BMI (24.7±7.8). These significant differences remained during the study period (22.8±6.7 versus 25.6±7.8). Interestingly, the values of the phase angle in DM patients were lower (3.5±1.3) during the study period compared with patients with tumour disease and control patients (3.5±1.3 versus 3.7±1.1, 3.5±1.3 versus 3.8±1.1). In contrast to published data, this study showed that IDPN was unable to improve BMI and phase angle in treated patients with DM or malignancy but was effective at improving the BMI of controls (22.8±9.6 versus 23.8±6.7). Moreover, serum albumin in patients with tumour disease increased (3.5±0.5 versus 3.7±0.4 g/dL). Although our study failed to demonstrate a significant IDPN-dependent improvement in the dietary status of chronic haemodialysis patients with DM or tumours, IDPN effectively prevented further deterioration of those patients with malnutrition. Even though meta-analyses point to the low quality of many IDPN studies,1 a positive influence of IDPN on food-related parameters can nevertheless be assumed.2 A clear statement on the long-term effects of IDPN cannot be made at present due to the lack of studies.1
The various approaches suggested to avoid malnutrition in haemodialysis patients point to the fact that, because of multifactorial causes,3 there are still insufficient therapeutic measures to identify patients at risk and start prevention; moreover, it is still under debate how to diagnose malnutrition. As discussed in the recent literature, and as our study shows, a range of parameters needs to be assessed for determination of nutritional status, because single-parameter assessment might lead to misclassification of patients. The biochemical laboratory parameters prealbumin, serum albumin, anthropogenic measurements, BMI, and the bioelectrical impedance analysis with phase angle determination should be assessed and assessment instruments that have been proven valid (subjective global assessment, Mini Nutritional Assessment short-form, and malnutrition, inflammation and atherosclerosis) should be utilised.3 In the opinion of the authors, dialysis patients should be regularly screened for malnutrition, and IDPN could be useful to prevent further nutritional deterioration in selected patients, despite its high costs.
