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Intradialytic Parenteral Nutrition

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

Patients on long term hemodialysis often suffer from malnutrition. In this lesson, we will learn about intradialytic parenteral nutrition as an option to improve nutritional status in patients receiving dialysis.

Human Filtering System

The human body is an amazing system that manages so many simultaneous processes! We put different things into our bodies by ingesting things orally, from sugary drinks, to potassium-rich bananas, to protein-filled steaks. Our bodies put these nutrients to use, but they must also deal with the excess in order to maintain a balanced body system. What do our bodies do with the things they can't use?

The kidneys are two organs located in our abdomen. They function as the body's filtering system. All the blood in our bodies is constantly filtering through our kidneys. Each kidney has about a million nephrons, which work to filter waste and excess fluid from the body. They help to balance electrolytes in our system as well, and produce urine to excrete these things from our bodies.

Kidney
kidney

Think about the water filter on your kitchen sink. It filters out many things from your drinking water. The kidneys are like an extremely high-tech version of that water filter! But what happens when your kidneys aren't working well?

Kidney Failure

When the kidneys aren't functioning to their full potential it is called kidney failure. Acute kidney failure is a sudden decline in kidney function, which can be due to a variety of possible issues, and it can be reversible. Chronic kidney failure is permanent damage to the kidneys. In end stage renal disease, kidney function is so poor that wastes and fluid are not adequately filtered out, and they accumulate in the blood. Electrolyte abnormalities also occur. A person with end stage renal disease requires hemodialysis to clean the blood.

Hemodialysis
hemodialysis

Hemodialysis is a medical procedure that uses a dialyzer or filter to clean the blood. A person is connected to the dialyzer by tubes attached to the blood vessels, and the blood is filtered through it to be cleaned of waste and excess fluids before being pumped back into the body. The dialyzer is acting as their kidneys! A person must have hemodialysis several times a week, either in a dialysis center or at home.

A person with renal disease also needs to be on a special diet to try to avoid the excess buildup of substances in their blood. Along with other contributing factors, a person with renal disease may experience malnutrition.

Intradialytic Parenteral Nutrition

Patients on hemodialysis require close monitoring of their nutritional status. Along with their specialized diet, they may have other issues that lead to inadequate nutritional intake, such as altered taste sensations, constipation, or the inability to prepare food for themselves. They also lose blood during dialysis and frequent blood draws, which contributes to their poor nutritional status.

Research shows that 18-70% of patients on long-term dialysis have malnutrition. Malnutrition is a strong factor in the mortality of these patients. The best option to correct their nutritional status is always the natural way - feeding through the gastrointestinal tract either through eating or a tube feeding, which is also called enteral feeding. This route has less chance for infection and requires smaller volumes to improve nutritional status. If a patient is unable to improve their nutritional status this way, they may be considered for intradialytic parenteral nutrition. Intradialytic parenteral nutrition (IDPN) is nutrition given intravenously during dialysis.

IDPN is a solution of amino acids, dextrose, and lipids that can provide 45 grams of protein and 735 kilocalories in a very short time. Several different studies have shown that IDPN did improve albumin and sometimes resulted in weight gain for patients. Albumin is protein measured in the blood and is an indicator of nutrition status.

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