Total Parenteral Nutrition in Patients with Kidney Disease

Total parenteral nutrition (TPN) may lead to concerning kidney outcomes with long-term administration. This can be delayed and improved by daily monitoring of the serum concentrations of clinical markers that correlate with kidney function but only in conjunction with changing the parenteral nutrition formula to account for these concentration changes. The current evidence suggests that hyperglycemia, hypertriglyceridemia, and deranged fluid/electrolyte balance remain significant areas of concern with TPN in patients with acute kidney injury, chronic kidney disease, and patients undergoing kidney replacement therapy. Tight monitoring of calorie intake, protein intake, and micronutrients is required in patients with end-stage kidney disease due to the high occurrence of protein-energy wasting or those undergoing kidney replacement therapy due to loss of nutrients during dialysis. Given the complications, TPN should only be used when enteral feeding is completely contraindicated or cannot sufficiently address nutrient intake goals due to secondary issues such as anorexia. These findings are discussed with the clinical practice guidelines recommended by The American Society for Parenteral and Enteral Nutrition and the European Society for Clinical Nutrition and Metabolism. Mechanisms of TPN-induced kidney diseases are also discussed.