Kidney Research and Clinical Practice (Jun 2012)

Impact of idpn on kt/v

  • Dukkipati R,
  • Moore E.,
  • VanBolt G,
  • Kalantar-Zadeh K

DOI
https://doi.org/10.1016/j.krcp.2012.04.583
Journal volume & issue
Vol. 31, no. 2
p. A82

Abstract

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The administration of intradialytic parenteral nutrition (IDPN) and the impact it has on Kt/V has not been thoroughly examined. The available literature addressing the influence of IDPN on Kt/V is limited and the observations are conflicting. Some studies have observed little or no significant change with IDPN administration. In contrast, one randomized, crossover study by McCann et al. of patients receiving IDPN observed a significant decrease. When amino acid (AA), dextrose and lipid components were administered a significant reduction in mean Kt/V resulted. When solutions containing only AA were administered, Kt/V was significantly less then when IDPN was withheld Administration of IDPN without AA resulted in a mean Kt/V not significantly different from the mean Kt/V when IDPN was withheld. AA containing IDPN reduced mean Kt/V by 18–23%. By personal communication with McCann, it was thought the amount of carbohydrate (CHO) determined whether the Kt/V was impacted when they studied further (unpublished). The authors found that by increasing the CHO, the Kt/V was not impacted (lower) and theorized that inadequate CHO resulted in catabolized protein generating urea. To investigate this further, a retrospective analysis was performed of the Pentec Health IDPN internal data base consisting of 489 patients that met inclusion and exclusion criteria. For this group: the age was 66.23+13.38 years; BMI was 25.79+56; 239 males (49%) and 250 females (51%); 304 patients with DM (62%); 430 patients with HTN (88%). Baseline albumin was 2.98+38 g/dL and baseline creatinine was 6.03+2.10 mg/dL. Results are below Table Kt/V (mean + SD) Baseline Month 1 Month 2 Month 3 1.65+.34 1.44+.36 1.43+.35 1.44+.34 A repeated measures ANOVA indicated a statistically significant difference (p<0.0001). A Tukey’s adjustment resulted in non-significant differences between month 1 and month 2 (p=0.995), month 1 and month 3 (p=0.987), and month 2 and month 3 (p=0.936). In conclusion, the initial decrease in Kt/V was followed by a period of stabilization, and the mean Kt/V never dropped below the KDOQI recommendation of 1.2.