Department of Nephrology, FISABIO, Hospital Universitari Doctor Peset, Valencia, Spain; Department of Medicine, Universitat de València, Spain; Multidisciplinary Renal Nutrition Working Group, Spanish Society of Nephrology, Spain.
Department of Nephrology, FISABIO, Hospital Universitari Doctor Peset, Valencia, Spain.
Clin Nutr ESPEN. 2024 Oct;63:322-331. doi: 10.1016/j.clnesp.2024.06.044. Epub 2024 Jul 1.
Intradialytic parenteral nutrition (IDPN) is a safe and effective patient-tailored nutritional strategy for providing nutrient supplementation to malnourished or at risk of malnutrition patients on hemodialysis (HD), who did not adequately respond to intensive dietary counselling and oral nutritional supplementation. Although IDPN is recommended by current ESPEN and KDOQI guidelines for nutrition in HD patients, none of these documents informs how to successfully implement this therapy, being the lack of knowledge on practical aspects of IDPN one of the main limitations to its use. The aim of this narrative review was to provide a practical roadmap for guiding the nephrologists, dietitians, and renal nurses in their everyday clinical practice about the use of IDPN.
A multidisciplinary group formed by specialists from the areas of Nephrology and Nutrition agreed to address different practical aspects related to IDPN in HD patients. Based on the available evidence in the literature and on the authors' clinical experience, different topics were selected to develop a detailed plan for implementing a successful experience with IDPN, proposing a practical IDPN roadmap.
This IDPN roadmap provides practical information on when an IDPN should be started; what type of nutrients should be part of an IDPN; how the IDPN should be administered; how the effectiveness and safety of the IDPN should be monitored; how to determine the effectiveness of IDPN; and the conditions that advise discontinuing the IDPN.
IDPN is a safe and effective nutritional therapy for HD patients, although the lack of staff training may limit its use. This review addresses different practical aspects of IDPN, helping interdisciplinary teams in their daily clinical practice to improve the nutritional care of HD patients, either malnourished or at risk of malnutrition.
间歇性透析期间的肠外营养（IDPN）是一种安全有效的个体化营养策略，可用于为接受血液透析（HD）的营养不良或有营养不良风险的患者提供营养补充，这些患者对强化饮食咨询和口服营养补充没有充分反应。虽然 IDPN 被目前的 ESPEN 和 KDOQI 指南推荐用于 HD 患者的营养治疗，但这些文件都没有说明如何成功实施这种治疗方法，对 IDPN 实际方面的了解不足是其使用的主要限制之一。本叙述性综述的目的是为肾脏病医生、营养师和肾脏护士提供一个实用的路线图，指导他们在日常临床实践中使用 IDPN。
一个由肾脏病学和营养学领域的专家组成的多学科小组同意解决与 HD 患者 IDPN 相关的不同实际方面。根据文献中的现有证据和作者的临床经验，选择了不同的主题，以制定一个详细的计划，以成功实施 IDPN 经验，提出一个实用的 IDPN 路线图。
该 IDPN 路线图提供了有关何时应开始 IDPN、IDPN 应包含哪些类型的营养素、如何进行 IDPN 管理、如何监测 IDPN 的有效性和安全性、如何确定 IDPN 的有效性以及建议停止 IDPN 的条件等方面的实用信息。
IDPN 是一种安全有效的 HD 患者营养治疗方法，尽管缺乏员工培训可能会限制其使用。本综述解决了 IDPN 的不同实际方面的问题，帮助跨学科团队在日常临床实践中改善 HD 患者的营养护理，无论是营养不良还是有营养不良风险的患者。
