Effect Of Partial Intradialytic Parenteral Nutrition In Hemodilysed Patients On Nurtrion Status

BackgroundProtein energy malnutrition(PEM),is prevalent in maintained hemodialysis(MHD) patients.One criterion of PEM strongly associated with morbidity and mortality in these dialysis patients is the serum albumin level.Serum albumin levels have not improed over the past 10 years.Typical intervention strategies need to be reevaluated. Intradialytic parenteral nutrition(IDPN) is a form of parenteral nutrition delivered during dialysis that is a assured route of nutrition alimentation for high-nutrition-risk PEW patients who cannot improve nutrition status by oral and enteral routes.It is necessary to make a study relating to the simple IDPN makes impact on the early stage of malnourished dialysis patients,whitch may lead us to find out an efficient and convenient nutrition therapy intervention for malnourished MHD patients.Objective:To assess the safety and efficiency of simple intradialytic parenteral nutrition as nutritional support in malnourished dialysis patients.Method:In this prospective,randomized,controlled study,the 36 patients was separated into 3 groups randomly:1)A1:control group;2)A2:receiving 50%glucose roup;3)A3: receiving 8.5%amino acid group.These patients were followed 4 weeks,whose parameter of nutrition status and assessments of the possible complications were examined befer and after the study.Results:1) By comparison of pre- and post-intervention,both glucose and amino acid groups demonstrated improvement in nutritional status,especially PA,TF,PCR increased most significantly(P＜0.05).While compared to the control group,serum levels of PA,TF,PCR had no increment significant(P＞0.05).2) In patients received 50%glucose,glutamic acid,tryptophan and leucine levels were significantly increased,with significant difference(P＜0.05).In patients received 50%glucose,glutamine,threonine,casein ammonia acid,valine, phenylalanine,leucine,amino acids and total amino acids were significantly increased(P＜0.05).Compared to the control group,there was an incremental tendency in the serum free amino except for arginine,but no significance(P＞0.05).Compared to the control group,essential amino-acid and total amino acids had a significant increment both in glucose group and amino acide group(P＜0.05),but there was no significance between these two groups.3) In three groups,triglycerides,cholesterol,low density lipoprotein and C-reactive protein were not significantly different(P＞0.05).In three groups,serum calcium,serum potassium,calcium and phosphorus product were not significant differences(P＞0.05).Received simple IDPN,there was no significant differences in CO2 content of plasma(P＞0.05).Conclusion:Simple dialysis parenteral nutrition intervention can improve the nutritional status of hemodialysis patients,but also can improve the status of serum amino acids.Furthermore,simple IDPN does not induce a pro-atherogenic lipid composition and influence inflammatory status enhancing the risk for atherosclerosis.Thus,simple IDPN is a safe and effective treatment to improve the nutrional status of malnourished henodialysis patients.