Associations of intradialytic parenteral nutrition with survival and changes in malnutrition risk among hemodialysis patients.

BACKGROUND & AIMS: Intradialytic parenteral nutrition (IDPN) is a form of partial nutritional support administered during dialysis sessions. This study evaluated the association between IDPN treatment, survival, and malnutrition risk in hemodialysis (HD) patients.

METHODS

Malutrition risk was assessed using the Integrative Clinical Nutrition Dialysis Score (ICNDS). From 2009 to 2014, patients at malnutrition risk received Standard Nutrition Care (SNC), including dietary counseling, a high-protein diet, tailored caloric intake, and oral supplementation. Patients unresponsive to SNC were subsequently treated with either continued SNC or SNC + IDPN, based on the treating physician's decision. From 2014 to 2019, all patients unresponsive to SNC were treated with SNC + IDPN. Survival was analyzed using the Cox proportional hazards model. The longitudinal changes in ICNDS, its seven parameters and slope of 3 subsequent monthly ICNDS values, were assessed using the Wilcoxon signed-rank test.

RESULTS

Mortality did not differ between the two SNC + IDPN groups in different years. Both had significantly lower mortality compared to the SNC-only treated group (Hazard Ratio [HR] = 0.3912, 95% Confidence Interval [95% CI] 0.162-0.950, p = 0.0381; from 2009 to 2014 HR = 0.30, 95% CI 0.14-0.643, p = 0.0019; from 2014 to 2019). ICNDS significantly improved three months after IDPN initiation, increasing from a median of 72 (Interquartile Range [IQR]: 66-74) to 75 (IQR: 69-78, p = 0.001). The median ICNDS slope improved from -4.5 (IQR: -8.0 to -3.5) to 3.25 (IQR: 0-4.75, p < 0.001). IDPN treatment also attenuated weight loss, improving from a baseline decline of -4.6% (IQR: -8.59 to -0.2) to 0.54% (IQR: -2.36-2.78, p = 0.011) of body weight after 3 months.

CONCLUSION

In HD patients at malnutrition risk, treatment with SNC + IDPN was associated with reduced 6-month mortality and improved nutritional outcomes compared to SNC alone.