Nutrition Therapy Chronic Dialysis

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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, first but not exclusively through decreased oral dietary intake due to diet restrictions and anorexia or e.g. nutrient losses during dialysis. However, also specific metabolic changes such as dialysis-induced catabolism, peripheral insulin resistance, hyperparathyroidism and metabolic acidosis may lead to malnutrition. 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.

Prescription

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.

Related Products – Prescription

Patient Access

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.

Preparation

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.

Application

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.