Intradialytic Total Parenteral Nutrition (IDPN): Evidence-Based Recommendations

Patients with end-stage renal disease on chronic hemodialysis have a high incidence of protein-energy malnutrition (PEM). The reasons for this are multi-factorial and include: inadequate food intake, a catabolic response to systemic illness or chronic inflammation, loss of nutrients through the dialysis procedure, as well as systemic effects of the uremic milieu. Intradialytic parenteral nutrition (IDPN) has been advocated for the management of malnutrition in hemodialysis patients. The rationale for its use is that patients are unable to increase oral intake to meet their nutritional needs or that the oral or enteral route is not effective in managing malnutrition in this group of patients. However, numerous studies using IDPN have failed to demonstrate efficacy conclusively with this very costly mode of treatment. This article reviews the literature evaluating the use of IDPN in the maintenance of hemodialysis patients and summarizes the existing recommendations and reimbursement guidelines for this therapy.