Nephrology Dialysis Transplantation, Vol 13, Issue 8 2081-2087, Copyright © 1998 by Oxford University Press
K Hiroshige, M Iwamoto, N Kabashima, Y Mutoh, K Yuu and A Ohtani
Background. The treatment of malnutrition, frequently
present in elderly dialysis patients, is important to promote better
quality of life and rehabilitation. The aim of this study was to assess the
impact of prolonged use of intradialysis parenteral nutrition (IDPN) as a
strategy for malnutrition in elderly haemodialysis patients.
Methods. Twenty-eight elderly patients (non-diabetic,
age over 70) on chronic haemodialysis for at least 2 years were evaluated.
Ten consenting patients were treated with IDPN containing glucose,
essential amino acids, and lipid emulsion during the course of regularly
scheduled dialysis treatments for approximately 1 year. Nutritional
evaluation using seven parameters (anthropometric measurements such as body
mass index, triceps skinfold thickness, mid-arm circumference, mid-arm
muscle circumference, and albumin, transferrin, and total lymphocyte count)
was performed at various intervals on patients with IDPN and 18 patients
without IDPN. The plasma amino-acid profile and dietary protein calorie
intake were also determined. Results. In patients
receiving IDPN, significant increases in serum albumin and transferrin
concentrations and total lymphocyte count in peripheral blood smears
paralleled increases in protein-calorie intake beginning after 3 months of
treatment and remained favourable throughout the study period.
Anthropometric data started to improve significantly after 6 months of
treatment. Patients without IDPN had gradual decreases in all parameters
during the study period. A significant increase in essential amino acids
and a significant decrease in 3-methyl-histidine were observed in patients
with IDPN and a further decrease in essential amino acids was observed in
patients without IDPN. Conclusion. Prolonged use of
IDPN prevents muscle protein catabolism and promotes body protein and fat
accumulation. IDPN appears to be effective in malnourished elderly
haemodialysis patients. Keywords: amino acids; elderly
patients; haemodialysis; intradialysis parenteral nutrition; malnutrition
PRELIMINARY REPORTS
Prolonged use of intradialysis parenteral nutrition in elderly malnourished chronic haemodialysis patients
2nd Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan; Department of Internal Medicine, Chikuho Hospital, Nougata City, Fukuoka, Japan; Correspondence to: K Hiroshige, Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu City, Fukuoka 807, Japan
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