Nutrition therapy for patients on chronic dialysis
Among patients undergoing chronic hemodialysis, approximately 20-30% show symptoms of malnutrition. 5-10% of patients already present with severe malnutrition, especially protein energy malnutrition. These effects are results from a number of underlying causes, e.g. nutrient losses during dialysis.
Malnutrition can increase morbidity and mortality and can significantly reduce the quality of life. Nutritional support directly during the dialysis procedure can achieve additional therapeutic benefits without additional time expenditures.
Guidelines recommend the use of intradialytic parenteral nutrition for patients with malnutrition if an adequate oral or enteral nutrition was not possible and a number of additional criteria is met. Screening tools such as the “Subjective Global Assessment” (SGA) are available to structure decision making.
Enteral Nutrition support is the provision of nutrients via the gastrointestinal tract by oral intake or through enteral feeding tubes.
Parenteral nutrition (PN) is defined as the supply of vital nutrients bypassing the digestive tract. Parenteral nutrition becomes necessary when it is not possible for the body to ingest sufficient nutrients via the oral/enteral route and to utilize these nutrients adequately. The choice between the enteral or parenteral route is decided very simply by the question "Is the gastrointestinal tract functional?"
Patients in need of chronic hemodialysis typically have an arterio-venous shunt to enable appropriate blood flow. Alternatively, catheters for dialysis such as Shaldon’s are applied. In non-acutely ill malnourished HD patients, IDPN is infused through the venous line during dialysis.
The preparation largely depends on the choice of the nutritional regime whether a ready-to-mix product or a compounded regime shall be used. The additional injection of vitamins and trace elements might be indicated. Goes without saying: thorough disinfection of devices and correct priming of the giving set is crucial.
Optimally, intradialytic nutrition is given via a volumetric infusion pump, such as Infusomat® Space, connected by a luer lock device to the venous access of the dialyzer.