Effect of intradialytic parenteral nutrition on mortality rates in end- stage renal disease care [see comments]
American Journal of Kidney Diseases. 1994; 23(6): 808-816.
Several studies have now demonstrated that low serum albumin and/or low protein catabolic rates correlate with increased risk of death in the chronic hemodialysis patient. A study involving 81 patients receiving thrice-weekly hemodialysis treatments and who had either a low serum albumin and/or protein catabolic rate was conducted to compare the effect of intradialytic parenteral nutrition (IDPN) on mortality rates. Fifty patients received IDPN and 31 patients did not. Thirty-eight of the patients were black (47%), 34 were white (42%), and 9 were Hispanic (11%). The study included 33 diabetic patients (41%), 20 of whom received IDPN. Nondiabetic patients received an average of 725 kcal/hemodialysis treatment and diabetic patients received an average of 670 kcal/hemodialysis treatment. The average length of treatment was 9 months. The results of the study revealed a better survival rate (64% v 52%) for patients treated with IDPN. Using Cox analysis, the IDPN- treated group had a significantly better survival rate (P < 0.01). Serum albumin increased by 12% in the survivors. There was no difference in survival when considered separately for diabetic and nondiabetic patients who received IDPN (mortality rate for diabetics: 50% for treated patients and 54% for untreated patients; mortality rate for nondiabetics: 26% for treated patients and 44% for untreated patients). However, the nondiabetic treated patients had the lowest mortality rates. In conclusion, correction of hypoalbuminemia by IDPN significantly reduced mortality rates overall
albumin; Analysis; Body Weight; Diabetic Nephropathies; Hemodialysis; Kidney Failure,Chronic; Middle Age; Mortality; Nutrition; Parenteral; Parenteral Nutrition; Parenteral-Nutrition; Patients; Retrospective Studies; Risk; Serum Albumin; Serum-Albumin; Survival Rate; Survival-Rate; United-States; Urea
RCT
Department of Medicine, Our Lady of Lourdes Medical Center, Camden, NJ 08103
