Kidney Week

Abstract: SA-PO435

Evaluation of Intradialytic Parenteral Nutrition Indication: Mirage or Reality?

Session Information

• Hemodialysis and Frequent Dialysis - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Martinez Vaquera, Shaira, Diaverum Espana, Madrid, Spain

Shaira Martinez Vaquera, MD

• Lupiañez-Barbero, Ascension, Diaverum Espana, Madrid, Spain

Ascension Lupiañez-Barbero, MS, MSc, RDN

• Alfaro Sanchez, Christian Israel, Diaverum Espana, Madrid, Spain

Christian Israel Alfaro Sanchez, MD

• Molina, Sonia Caparros, Diaverum Espana, Madrid, Spain

Sonia Caparros Molina, MD

• Pizarro Leon, Jose Luis, Diaverum Espana, Madrid, Spain

Jose Luis Pizarro Leon, DrMed

• Martinez Sanchez, Teresa, Diaverum Espana, Madrid, Spain

Teresa Martinez Sanchez, MD

• Sorribes López, Maria Paz, Diaverum Espana, Madrid, Spain

Maria Paz Sorribes López, RN

Group or Team Name

• Diaverum Spain Team.

Background

The estimated prevalence of protein energy wasting (PEW) in haemodialysis (HD) is between 28-54%, and may be even higher¹. Different nutritional strategies are available: dietary advice by a Dietitian-Nutritionist (DN), oral nutrition (ONS) or Intradialytic parenteral nutrition (IDPN), among others². The economic cost or the lack of DN in dialysis units are barriers that limit its use. Objective: To determine the prevalence of HD patients who are potential candidates for IDPN.

Methods

Descriptive, retrospective and multicentre study of 3544 patients who responded to the KDQOL-SFTMV^1.3 surveys during 2022. We analysed the generic part (SF-36), the Summative Physical (ISF) and Mental Index (ISM)³. We collected demographic and clinical data, used the DPE scale⁴ and the expert consensus⁵ as screening for PIND. We assessed normality and performed non-parametric statistics.

Results

62.4% male, 73 years, BMI 25.8kg/m2 , albumin 3.93g/dl, creatinine 6.5mg/dl , CRPn 0.98 g/kg/d, FSI 49.14 [39.58-55.69], MSI 34.88 [27.75-42.55]. 45.4% had DM, 60.9% were on dialysis with AVF and 35 months on HD [15-67]. According to DPE screening components: 33% albumin <3.8g/dl; 4.1% creatinine <3.8mg/dl; 26.3% BMI <23kg/m2; 20.8% nCRP <0.8g/kg/d. 59.2% had some degree of malnutrition. 21.3% could be candidates for NPID due to moderate-severe malnutrition. According to expert consensus: 27.4% albumin <3.8g/dl plus creatinine <8mg/dl; 3% BMI <18.5kg/m2; 14.4% CRPn <0.75g/kg/d; 0.6% weight loss> 10% in the last 6 months. Only 0.23% met at least 3 of these criteria and would be candidates for NPID. We observed association between nutritional status and quality of life (QoL) (table 1).

Conclusion

We found huge discrepancy in the prevalence of patients who were candidates for NPID according to the criteria used. The decision to provide NPID not only impacts on the clinical prognosis and QoL of the patient, but also entails relevant costs that could be avoided.

Funding

• Private Foundation Support