Kittiskulnam Piyawan, Banjongjit Athiphat, Metta Kamonchanok, Tiranathanagul Khajohn, Avihingsanon Yingyos, Praditpornsilpa Kearkiat, Tungsanga Kriang, Eiam-Ong Somchai
Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
Sci Rep. 2022 Mar 16;12(1):4529. doi: 10.1038/s41598-022-08726-8.
In hemodialysis (HD) patients, protein-energy wasting (PEW) is highly prevalent and firstly treated with oral nutritional supplements (ONS). The extent to which intradialytic parenteral nutrition (IDPN) contributes to improve PEW status in HD patients intolerable to ONS remains unclear. Maintenance PEW HD patients being unable to tolerate ONS adverse effects, and having spontaneous energy and protein intake of ≥ 20 kcal/kg/day and ≥ 0.8 g/kg/day, respectively were randomly assigned 1:1 into IDPN and control groups. In IDPN group, most concentrated 3-in-1, fish-oil based parenteral nutrition was infused during HD for 3 months. The control group received intensive dietary counselling once weekly for 3 months. Both groups were then followed for additional 3 months after intervention. A total of 38 patients were randomized (mean age 67.6 years). After 3 months, serum albumin was significantly higher in the IDPN (n = 18) compared with control group (from 3.5 ± 0.3 to 3.8 ± 0.2 vs from 3.6 ± 0.3 to 3.5 ± 0.3 g/dL, respectively, p = 0.01). Spontaneous dietary intake (p = 0.04), body weight (p = 0.01), and malnutrition inflammation score (MIS, p = 0.01) were improved in the IDPN, but not in the control group. Muscle mass, strength, serum prealbumin, interleukin-6, high sensitivity-c reactive protein, and acylated ghrelin were not significantly different but leptin levels increased in the control group after 3 months (p = 0.03). At 6 months, serum albumin in the IDPN group was persistently higher than baseline (p = 0.04). Neither volume overload nor uncontrolled hyperglycemia was found throughout the study. In conclusion, a 3-month IDPN supplementation demonstrated a significant increase in serum albumin, body weight, spontaneous oral intake, and MIS; and appeared to be superior to continuing intensive dietary counselling among HD patients intolerable to ONS. The impacts of IDPN therapy on clinical outcomes may require larger scale with longer period of study.
在血液透析（HD）患者中，蛋白质 - 能量消耗（PEW）非常普遍，首先采用口服营养补充剂（ONS）进行治疗。对于无法耐受ONS的HD患者，透析期间肠外营养（IDPN）在改善PEW状态方面的作用程度尚不清楚。将无法耐受ONS不良反应、自发能量摄入≥20千卡/千克/天且蛋白质摄入≥0.8克/千克/天的维持性PEW HD患者按1:1随机分为IDPN组和对照组。IDPN组在HD期间输注最浓缩的基于鱼油的三合一肠外营养，持续3个月。对照组每周接受一次强化饮食咨询，持续3个月。干预后两组均再随访3个月。共有38例患者被随机分组（平均年龄67.6岁）。3个月后，IDPN组（n = 18）的血清白蛋白显著高于对照组（分别从3.5±0.3升至3.8±0.2与从3.6±0.3降至3.5±0.3克/分升，p = 0.01）。IDPN组的自发饮食摄入量（p = 0.04）、体重（p = 0.01）和营养不良炎症评分（MIS，p = 0.01）得到改善，而对照组未改善。肌肉质量、力量、血清前白蛋白、白细胞介素 - 6、高敏C反应蛋白和酰基化胃泌素无显著差异，但3个月后对照组的瘦素水平升高（p = 0.03）。6个月时，IDPN组的血清白蛋白持续高于基线水平（p = 0.04）。在整个研究过程中未发现容量超负荷或未控制的高血糖。总之，3个月的IDPN补充显示血清白蛋白、体重、自发口服摄入量和MIS显著增加；在无法耐受ONS的HD患者中，似乎优于持续的强化饮食咨询。IDPN治疗对临床结局的影响可能需要更大规模、更长时间的研究。
