The Administration of Intradialytic Parenteral Nutrition Does Not Affect the Anemia Status of Chronic Kidney Disease Patients Undergoing Hemodialysis

Decsa Medika Hertanto; Arvi Dian Prasetia Nurwidda; Artaria Tjempakasari; Widodo Widodo; Pranawa Pranawa

doi:10.32867/inakidney.v1i1.115

Decsa Medika Hertanto Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya https://orcid.org/0000-0002-3639-2152
Arvi Dian Prasetia Nurwidda Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya https://orcid.org/0000-0003-4095-9868
Artaria Tjempakasari Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya https://orcid.org/0000-0003-3264-8568
Widodo Widodo Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya
Pranawa Pranawa Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya https://orcid.org/0000-0002-8729-742X

DOI: https://doi.org/10.32867/inakidney.v1i1.115

Keywords: chronic kidney disease, anemia, parenteral nutrition, hemodialysis, nephrology

Abstract

Background: Hemodialysis (HD) patients are susceptible to malnutrition, and there is a close relationship between malnutrition and the incidence of anemia. Parenteral nutrition plays a role in treating malnutrition.

Objective: This study aims to determine the effect of parenteral nutrition on anemia in HD patients.

Methods: Quasi-experimental research which is part of the nutritional research tree at the Hemodialysis Unit of RSUP Dr. Soetomo Surabaya for 3 months. A total of 45 malnourished CKD patients (SGA B & C) undergoing routine HD were included in this study (n=26 received regular diet & education, n=17 received regular diet, education and intradialytic parenteral nutrition, and n=2 dropped out of school due to blood transfusion). Measurements of body mass index (BMI), hemoglobin (Hb), serum iron (SI), and total iron binding capacity (TIBC) were carried out before and 8 weeks after therapy. Between groups used the Mann-Whitney test, while pre and post used the Wilcoxon matched-pairs sign rank test.

Results: The treatment group was older than the control group. There was no difference in duration of HD between groups. Intradialytic parenteral nutrition had no effect on BMI (24.71±3.939 vs 24.71±4.026; p=0.3802), Hb (9.746±1.309 vs 9.162±1.960; p= 0.3525), SI (62.33±34.74 vs. 53.78±24.89; p=0.3594), and TIBC (242.8±119.0 vs. 197.3±43, 65; p=0.4258).

Conclusion: In HD patients, intradialytic parenteral nutrition for 8 weeks did not affect Hb, SI and TIBC levels. Long-term observations with larger samples are needed to confirm these findings.

Downloads

Download data is not yet available.

References

Portolés J, Martín L, Broseta JJ, Cases A. Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Front Med (Lausanne). 2021;8:642296.

Sahathevan S, Khor BH, Ng HM, Gafor AHA, Mat Daud ZA, Mafra D, et al. Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review. Nutrients. 2020 Oct 15;12(10):3147.

Cano NJM, Aparicio M, Brunori G, Carrero JJ, Cianciaruso B, Fiaccadori E, et al. ESPEN Guidelines on Parenteral Nutrition: adult renal failure. Clin Nutr. 2009 Aug;28(4):401–14.

Radić J, Bašić-Jukić N, Vujičić B, Klarić D, Radulović G, Jakić M, et al. Anemia Is Correlated with Malnutrition and Inflammation in Croatian Peritoneal Dialysis Patients: A Multicenter Nationwide Study. Perit Dial Int. 2017;37(4):472–5.

Zha Y, Qian Q. Protein Nutrition and Malnutrition in CKD and ESRD. Nutrients. 2017 Feb 27;9(3):208.

Cano NJM, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, et al. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol. 2007 Sep;18(9):2583–91.

Kittiskulnam P, Banjongjit A, Metta K, Tiranathanagul K, Avihingsanon Y, Praditpornsilpa K, et al. The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial. Sci Rep. 2022 Mar 16;12(1):4529.

Czekalski S, Hozejowski R, Malnutrition Working Group. Intradialytic amino acids supplementation in hemodialysis patients with malnutrition: results of a multicenter cohort study. J Ren Nutr. 2004 Apr;14(2):82–8.

Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol. 2014 Sep;25(9):2088–96.

Marsen TA, Beer J, Mann H, German IDPN-Trial group. Intradialytic parenteral nutrition in maintenance hemodialysis patients suffering from protein-energy wasting. Results of a multicenter, open, prospective, randomized trial. Clin Nutr. 2017 Feb;36(1):107–17.