Chronic Kidney Disease

CKD: Protein Energy Supplements: IDPN (2018)

• Intervention
  What is the effect of nutritional supplementation via IDPN on mortality and hospitalizations in adults with CKD on hemodialysis?

  • Conclusion

    In patients on hemodialysis (HD) with protein-energy malnutrition, protein and energy supplementation via intradialytic parenteral nutrition (IDPN) and oral nutritional supplement (ONS) to meet target protein and energy levels did not affect mortality or hospitalization rates compared to ONS alone.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of nutritional supplementation via IDPN on mortality and hospitalizations in adults with CKD on hemodialysis?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cano N, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Laville M, Leverve X. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. Journal of the American Society of Nephrology 2007; 18:2583-91
  • Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
     
  What is the effect of nutritional supplementation via IDPN on anthropometrics in adults with CKD on hemodialysis?

  • Conclusion

    In patients on hemodialysis with protein-energy malnutrition, intradialytic parenteral nutrition (IDPN) therapy improved anthropometric measurements compared to control interventions. An IDPN formulation with essential amino acids (EAAs) did not affect anthropometric measurements compared to a standard formulation with EAAs and non-essential amino acids (NEAAs).

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of nutritional supplementation via IDPN on anthropometrics in adults with CKD on hemodialysis?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cano N, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Laville M, Leverve X. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. Journal of the American Society of Nephrology 2007; 18:2583-91
      • Hiroshige K, Iwamoto M, Kabashima N, Mutoh Y, Yuu K, Ohtani A. Prolonged use of intradialysis parenteral nutrition in elderly malnourished chronic haemodialysis patients. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 1998; 13:2081-7
      • Toigo G, Situlin R, Tamaro G, Del Bianco A, Giuliani V, Dardi F, Vianello S, Toffoletto P, Faccini L, Guarnieri G. Effect of intravenous supplementation of a new essential amino acid formulation in hemodialysis patients. Kidney International. Supplement 1989; 27:S278-81
  • Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
     
  What is the effect of nutritional supplementation via IDPN on CRP levels in adults with CKD on hemodialysis?

  • Conclusion

    In malnourished patients on hemodialysis, protein and energy supplementation via intradialytic parenteral nutrition (IDPN) and oral nutritional supplements (ONS) to meet target protein and energy levels did not affect CRP levels compared to ONS alone.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of nutritional supplementation via IDPN on CRP levels in adults with CKD on hemodialysis?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cano N, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Laville M, Leverve X. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. Journal of the American Society of Nephrology 2007; 18:2583-91
  • Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
     
  What is the effect of nutritional supplementation via IDPN on hemoglobin levels in adults with CKD on hemodialysis?

  • Conclusion

    In patients on hemodialysis (HD) with protein-energy malnutrition, an intradialytic parenteral nutrition (IDPN) formulation with essential amino acids (EAAs) did not affect hemoglobin levels compared to a standard formulation with EAAs and non-essential amino acids (NEAAs).

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of nutritional supplementation via IDPN on hemoglobin levels in adults with CKD on hemodialysis?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Toigo G, Situlin R, Tamaro G, Del Bianco A, Giuliani V, Dardi F, Vianello S, Toffoletto P, Faccini L, Guarnieri G. Effect of intravenous supplementation of a new essential amino acid formulation in hemodialysis patients. Kidney International. Supplement 1989; 27:S278-81
  • Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
     
  What is the effect of nutritional supplementation via IDPN on triglyceride and total cholesterol levels in adults with CKD on hemodialysis?

  • Conclusion

    Intradialytic parenteral nutrition (IDPN) therapy did not affect total cholesterol or triglyceride levels in hemodialysis patients with protein-energy malnutrition, but evidence was limited. 

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of nutritional supplementation via IDPN on triglyceride and total cholesterol levels in adults with CKD on hemodialysis?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cano N, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Laville M, Leverve X. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. Journal of the American Society of Nephrology 2007; 18:2583-91
      • Hiroshige K, Iwamoto M, Kabashima N, Mutoh Y, Yuu K, Ohtani A. Prolonged use of intradialysis parenteral nutrition in elderly malnourished chronic haemodialysis patients. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 1998; 13:2081-7
  • Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)
     
  What is the effect of nutritional supplementation via IDPN on nutritional status indicators in adults with CKD on hemodialysis?

  • Conclusion

    In hemodialysis (HD) patients with protein-energy malnutrition, intradialytic parenteral nutriiton (IDPN) supplementation improved albumin levels. An IDPN formulation with essential amino acids (EAAs) did not affect albumin levels compared to a standard formulation with EAAs and non-essential amino acids (NEAAs). In malnourished HD patients, protein and energy supplementation via IDPN and oral nutritional supplements (ONS) to meet target protein and energy levels may increase pre-albumin levels compared to ONS alone. In HD patients with protein-energy malnutrition, IDPN supplementation increased transferrin levels.  An IDPN formulation with EAAs did not affect transferrin levels compared to a standard formulation with EAAs and NEAAs. In malnourished HD patients, protein and energy supplementation via IDPN and ONS to meet target protein and energy levels did not affect normalized protein nitrogen appearance (nPNA) compared to ONS alone. 
     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of nutritional supplementation via IDPN on nutritional status indicators in adults with CKD on hemodialysis?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cano N, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Laville M, Leverve X. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. Journal of the American Society of Nephrology 2007; 18:2583-91
      • Hiroshige K, Iwamoto M, Kabashima N, Mutoh Y, Yuu K, Ohtani A. Prolonged use of intradialysis parenteral nutrition in elderly malnourished chronic haemodialysis patients. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 1998; 13:2081-7
      • Toigo G, Situlin R, Tamaro G, Del Bianco A, Giuliani V, Dardi F, Vianello S, Toffoletto P, Faccini L, Guarnieri G. Effect of intravenous supplementation of a new essential amino acid formulation in hemodialysis patients. Kidney International. Supplement 1989; 27:S278-81
  • Search Plan and Results: CKD: Macronutrients : Nutritional Supplements (2018)