Slusser-Hogan Maiya, Haight Jamie, Gabriel Lori, Hardy Mark A, Hehenberger Karin
Patient Care America, Pompano Beach, Florida.
Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Kidney360. 2025 Sep 1;6(9):1532-1540. doi: 10.34067/KID.0000000789. Epub 2025 Apr 1.
Intradialytic parenteral nutrition (IDPN) is a safe therapy with improvement in serum albumin levels, a marker of morbidity and mortality in patients on hemodialysis. Clinically significant improvements in albumin levels can be observed within 2 months of initiation of IDPN use. Research on IDPN is needed to identify benefits of its use in subgroups and on important clinical outcomes (., quality of life, hospitalization, and mortality).
Albumin is an established survival surrogate in dialysis. We evaluated the effect of intradialytic parenteral nutrition (IDPN) on albumin levels in patients with ESKD undergoing in-center hemodialysis and determined characteristics associated with response to IDPN treatment.
We conducted a 5-year (May 2018–April 2023) retrospective chart review of 2270 patients on in-center hemodialysis from 1039 dialysis centers, in 43 states and the District of Columbia, who received concurrent IDPN treatment three times per week. Patients were aged 18 years and older (mean 69.1 years) with albumin levels <4.0 g/dl (mean 3.11 g/dl) and were on hemodialysis for more than 6 months (mean 3.7 years). Other criteria included unintentional weight loss (≥5%/3 months) and/or body mass index below 20 kg/m. The coprimary end points included mean change in albumin levels from baseline to month 6 of IDPN therapy and percentage of patients with a clinically significant change in albumin levels, defined as ≥0.2 g/d with a < 0.05. Each patient studied was their own control. We used Kaplan–Meier curves to evaluate the time to positive IDPN response. Two-sample tests for continuous variables and Chi-square tests for categorical variables were used to determine whether certain defined patient characteristics were associated with a positive response to IDPN therapy.
One thousand nine hundred forty-six eligible patients consented to being evaluated. Baseline demographics include 50.9% female and 49.1% male with a mean albumin of 3.11 g/dl. Evaluable data at 6 months were available for 73% of patients. Mean change in albumin levels from baseline to 6 months after initiation of IDPN therapy was 0.330 g/dl; 82.0% of patients achieved ≥0.2-g/dl increase in albumin level within those 6 months. Younger age and lower baseline albumin levels were significantly and independently associated with a higher and more rapid significant rise, < 0.05, in albumin levels. While receiving IDPN, fewer than 8% of patients reported minimal and treatable side effects.
IDPN is a safe and effective therapy resulting in clinically significant improvement in serum albumin levels. Further research on associated outcomes and quality-of-life data is needed.
透析期间胃肠外营养（IDPN）是一种安全的治疗方法，可提高血清白蛋白水平，而血清白蛋白水平是血液透析患者发病和死亡的一个指标。在开始使用IDPN的2个月内可观察到白蛋白水平有临床显著改善。需要对IDPN进行研究，以确定其在亚组中的使用益处以及对重要临床结局（如生活质量、住院率和死亡率）的影响。
白蛋白是透析中公认的生存替代指标。我们评估了透析期间胃肠外营养（IDPN）对接受中心血液透析的终末期肾病（ESKD）患者白蛋白水平的影响，并确定了与IDPN治疗反应相关的特征。
我们对来自43个州和哥伦比亚特区1039个透析中心的2270例接受中心血液透析且每周同时接受3次IDPN治疗的患者进行了为期5年（2018年5月至2023年4月）的回顾性病历审查。患者年龄在18岁及以上（平均69.1岁），白蛋白水平<4.0 g/dl（平均3.11 g/dl），且血液透析时间超过6个月（平均3.7年）。其他标准包括非故意体重减轻（≥5%/3个月）和/或体重指数低于20 kg/m²。共同主要终点包括从基线到IDPN治疗第6个月白蛋白水平的平均变化，以及白蛋白水平有临床显著变化（定义为≥0.2 g/d且P<0.05）的患者百分比。每个研究患者均以自身作为对照。我们使用Kaplan–Meier曲线评估IDPN产生阳性反应的时间。采用连续变量的两样本t检验和分类变量的卡方检验来确定某些特定定义的患者特征是否与IDPN治疗的阳性反应相关。
1946例符合条件的患者同意接受评估。基线人口统计学数据包括50.9%为女性，49.1%为男性，平均白蛋白水平为3.11 g/dl。73%的患者有6个月时的可评估数据。IDPN治疗开始后，从基线到6个月白蛋白水平的平均变化为0.330 g/dl；在这6个月内，82.0%的患者白蛋白水平升高≥0.2 g/dl。年龄较小和基线白蛋白水平较低与白蛋白水平显著且独立地更高、更快的显著升高（P<0.05）相关。在接受IDPN治疗期间，不到8%的患者报告有轻微且可治疗的副作用。
IDPN是一种安全有效的治疗方法，可使血清白蛋白水平有临床显著改善。需要对相关结局和生活质量数据进行进一步研究。
