Hemodialysis (HD) Patients with Liver Disease: Intradialytic Parenteral Nutrition (IDPN)

153 MEETING ABSTRACTS 13. HEMODIALYSIS (HD) PATIENTS WITH LIVER DISEASE: INTRADIALYTIC PARENTERAL NUTRITION (IDPN). Eileen Moore, Gerald VanBolt, Pentec Health Inc., Boothwyn, PA USA Calorie and protein needs of the patient with liver disease or chronic kidney disease are determined by: assessment of nutritional status, as influenced by clinical stability and severity and/or advancement of the disease. Metabolic alterations associated with either advancement of liver disease or chronic kidney disease stage 5 dialysis (CKD-5 dialysis) may predispose patients to protein calorie malnutrition and muscle wasting. Studies of parenteral nutrition in patients with liver disease or CKD-5 dialysis have demonstrated improvements in nutritional parameters however analysis of nutritional response to IDPN in malnourished patients with both liver disease and advanced kidney disease requiring chronic hemodialysis is limited to case study reports. A retrospective analysis was performed using the Pentec Health internal data base. 105 hemodialysis patients with liver disease receiving IDPN met inclusion and exclusion criteria. IDPN regimens varied in substrate content: protein in the range of 1.3 to 1.6 g/kg; dextrose in the range of <3-8mg.kg/min); with some patients also receiving lipid. Table of albumin results are shown below. I II D DD P PP N NN R RR E EE S SS P PP O OO N NN S SS E EE I II N NN H HHD DD P PP A AA T TT I II E EE N NN T TT S SS W WWI II T TT H HH L LL I II V VV E EE R RR D DD I II S SS E EE A AA S SS E EE ( (( n nn = ==1 11 0 00 5 55 ) )) PRE-IDPN ALBUMIN 3 MO. MEAN ALBUMIN MEAN INCREASE ALBUMIN ALBUMIN (g/dL) 2.87 + 0.45 3.05 + 0.54 0.18 + 0.47 A t –test indicated a statistically significant difference in albumin from baseline to month 3 (p=0.0001). Baseline creatinine 6.62 + 2.18mg/dL was indicative of low muscle mass. Baseline Kt/V was 1.54 + 0.32 indicative of adequate dialysis. In conclusion, there was a statistically significant increase in albumin among liver disease patients on hemodialysis who received IDPN which may be indicative of increased protein synthesis. There is a need for further research regarding this topic.

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Transcript of Hemodialysis (HD) Patients with Liver Disease: Intradialytic Parenteral Nutrition (IDPN)

Page 1: Hemodialysis (HD) Patients with Liver Disease: Intradialytic Parenteral Nutrition (IDPN)

153MEETING ABSTRACTS

13. HEMODIALYSIS (HD) PATIENTS WITH LIVER DISEASE: INTRADIALYTIC PARENTERAL NUTRITION (IDPN). Eileen Moore, Gerald VanBolt, Pentec Health Inc., Boothwyn, PA USA

Calorie and protein needs of the patient with liver disease or chronic kidney disease are determined by: assessment of nutritional status, asinfluenced by clinical stability and severity and/or advancement of the disease. Metabolic alterations associated with either advancement of liver disease or chronic kidney disease stage 5 dialysis (CKD-5dialysis) may predispose patients to protein calorie malnutrition and muscle wasting.

Studies of parenteral nutrition in patients with liver disease or CKD-5dialysis have demonstrated improvements in nutritional parameters however analysis of nutritional response to IDPN in malnourished patients with both liver disease and advanced kidney disease requiring chronic hemodialysis is limited to case study reports.

A retrospective analysis was performed using the Pentec Health internal data base. 105 hemodialysis patients with liver disease receiving IDPN met inclusion and exclusion criteria. IDPN regimens varied in substrate content: protein in the range of 1.3 to 1.6 g/kg; dextrose in the range of <3-8mg.kg/min); with some patients also receiving lipid. Table of albumin results are shown below.

IIIDDDPPPNNN RRREEESSSPPPOOONNNSSSEEE IIINNN HHHDDD PPPAAATTTIIIEEENNNTTTSSS WWWIIITTTHHH LLLIIIVVVEEERRR DDDIIISSSEEEAAASSSEEE (((nnn===111000555)))PRE-IDPN ALBUMIN 3 MO. MEAN

ALBUMIN MEAN INCREASE ALBUMIN

ALBUMIN (g/dL)

2.87 + 0.45

3.05 + 0.54

0.18 + 0.47 A t –test indicated a statistically significant difference in albumin from baseline to month 3 (p=0.0001). Baseline creatinine 6.62 + 2.18mg/dL was indicative of low muscle mass. Baseline Kt/V was 1.54 + 0.32 indicative of adequate dialysis. In conclusion, there was a statistically significant increase in albumin among liver disease patients on hemodialysis who received IDPN which may be indicative of increased protein synthesis. There is a need for further research regarding this topic.