Intradialytic Parenteral Nutrition During In-Center Hemodialysis of Patients Leads to Increase in Albumin Without Compromising Safety: Retrospective Analysis.

Abstract

Background: Albumin is an established survival surrogate in dialysis. We evaluated the effect of intradialytic parenteral nutrition (IDPN) on albumin levels in patients with end-stage renal disease (ESRD) undergoing in-center hemodialysis (ICHD) and determined characteristics associated with response to IDPN treatment.

Methods: We conducted a 5-year (05/2018 - 04/2023) retrospective chart review of 2,270 ICHD patients from 1039 Dialysis Centers, in 43 states and D.C., who received concurrent IDPN treatment 3 times per week. Patients were ≥18y (mean 69.1y) with albumin levels <4.0 g/dl (mean 3.11g/dl) and were on HD for more than 6 mos (mean 3.7 years). Other criteria included unintentional weight loss (≥5%/3mo) and/or BMI below 20kg/m2. The co-primary endpoints included mean change in albumin levels from baseline to month 6 of IDPN therapy and percentage of patients with a clinically significant change in albumin levels, defined as ≥0.2 g/d with a p<0.05. Each patient studied was their own control. We used Kaplan-Meier curves to evaluate the time to positive IDPN response. Two-sample t-tests for continuous variables and Chi-square tests for categorical variables were used to determine if certain defined patient characteristics were associated with a positive response to IDPN therapy.

Results: 1,946 eligible patients consented to being evaluated. Baseline demographics (Table 1) include: 50.9% female and 49.1% male with a mean albumin of 3.11g/dL. Evaluable data at six months were available for 73% of patients. Mean change in albumin levels from baseline to 6 months after initiation of IDPN therapy was 0.330 g/dL; 82.0% of patients achieved ≥0.2-g/dL increase in albumin level within those six months. Younger age and lower baseline albumin levels were significantly and independently associated with a higher and more rapid significant rise, p <0.05, in albumin levels. While receiving IDPN, fewer than 8% of patients reported minimal and treatable side effects.

Conclusion: IDPN is a safe and effective therapy resulting in clinically significant improvement in serum albumin levels. Further research on associated outcomes and QoL data is needed.