INTRADIALYTIC PARENTERAL NUTRITON (IDPN) – DO WE PRACTICE WHAT WE PREACH?
Mr Anthony Meade1, Ms Yujing Liu2
1Royal Adelaide Hospital, Adelaide, Australia, 2Flinders University, Bedford Park, Australia
Aim: To review 15 years of IDPN clinical practice and compare with recently published reviews and clinical practice guidelines.
Background: Historically IDPN has been used as a “rescue therapy” when other nutrition support strategies have failed. However, recently published reviews have suggested the people most likely to benefit from IDPN are clinically stable receiving maintenance haemodialysis (HD), who have or are at risk of mild-moderate malnutrition, who have substantial but not adequate oral intake, and who receive IDPN for >3 months.
Methods: Retrospective casenote audit of all patients who received IDPN within Central Northern Adelaide Renal and Transplantation Service from 2007-2024. Reasons for IDPN commencement, nutritional status, clinical goals and outcomes, duration of IDPN and reasons for cessation were compared to guidelines to critically appraise our clinical practice.
Results: 94 people received lipid-only IDPN over 102 separate episodes. Mean haemodialysis vintage was 42 months, age 67 years and duration of IDPN 8 months. Over 17 years the formulation changed from Intralipid® to Clinoleic® to SMOF Lipid® with >90% receiving 500ml per HD session. 75 out of 94 people received IDPN for >3 months. Sudden death and palliation were the most common reasons for IDPN duration <3 months. Lipid-only IDPN is well tolerated with no direct IDPN side-effects documented. Based on documented goals, being clinically stable, having spontaneous but sub-optimal oral intake and mild-moderate malnutrition were correlated with successful outcomes.
Conclusions: IDPN is unlikely to benefit clinically unstable people receiving HD. Our clinical experience agrees with published guidelines that lipid-only IDPN prescribed to clinically stable people with mild-moderate malnutrition receiving HD who have spontaneous but sub-optimal oral intake are most likely to benefit from IDPN.
Biography:
Advanced Renal Dietitian, Royal Adelaide Hospital, SA. Experienced Renal Dietitian and clinical educator. Convenor, Renal Nutrition Program. Kidney disease nutrition research interests are patient-centred and practical.