Evaluation of Intradialytic Parenteral Nutrition Indication: Mirage or Reality?

Abstract

Background: The estimated prevalence of protein energy wasting (PEW) in haemodialysis (HD) is between 28-54%, and may be even higher1. Different nutritional strategies are available: dietary advice by a Dietitian-Nutritionist (DN), oral nutrition (ONS) or Intradialytic parenteral nutrition (IDPN), among others2. The economic cost or the lack of DN in dialysis units are barriers that limit its use. Objective: To determine the prevalence of HD patients who are potential candidates for IDPN. Methods: Descriptive, retrospective and multicentre study of 3544 patients who responded to the KDQOL-SFTMV1.3 surveys during 2022. We analysed the generic part (SF-36), the Summative Physical (ISF) and Mental Index (ISM)3. We collected demographic and clinical data, used the DPE scale4 and the expert consensus5 as screening for PIND. We assessed normality and performed non-parametric statistics. Results: 62.4% male, 73 years, BMI 25.8kg/m2 , albumin 3.93g/dl, creatinine 6.5mg/dl , CRPn 0.98 g/kg/d, FSI 49.14 [39.58-55.69], MSI 34.88 [27.75-42.55]. 45.4% had DM, 60.9% were on dialysis with AVF and 35 months on HD [15-67]. According to DPE screening components: 33% albumin <3.8g/dl; 4.1% creatinine <3.8mg/dl; 26.3% BMI <23kg/m2; 20.8% nCRP <0.8g/kg/d. 59.2% had some degree of malnutrition. 21.3% could be candidates for NPID due to moderate-severe malnutrition. According to expert consensus: 27.4% albumin <3.8g/dl plus creatinine <8mg/dl; 3% BMI <18.5kg/m2; 14.4% CRPn <0.75g/kg/d; 0.6% weight loss> 10% in the last 6 months. Only 0.23% met at least 3 of these criteria and would be candidates for NPID. We observed association between nutritional status and quality of life (QoL) (table 1). Conclusion: We found huge discrepancy in the prevalence of patients who were candidates for NPID according to the criteria used. The decision to provide NPID not only impacts on the clinical prognosis and QoL of the patient, but also entails relevant costs that could be avoided. Funding: Private Foundation Support