Comparative study between enteral and intradialytic parenteral nutrition in hemodialysis patients

Background Protein–energy malnutrition is very common among patients with end-stage renal disease undergoing maintenance hemodialysis therapy. Aim The aim of this prospective randomized study was to compare the effect of enteral nutrition (EN) and intradialytic parenteral nutrition (IDPN) on malnourished hemodialysis patients receiving nutritional support admitted in the intensive care unit. Patients and methods A total of 135 patients between 18 and 60 years of age admitted in Ain shams University Hospitals’ intensive care units and on regular hemodialysis were randomly allocated to three groups of 45 each. Group A received enteral and IDPN (250 ml dextrose 25%, 250 ml intralipid 10%, 250 nephrosteril 7%, and trace elements and vitamins). Group B received enteral and IDPN (250 ml dextrose 25%, 250 ml intralipid 10%, 250 aminosteril N-Hepa 8%, and trace elements and vitamins). Group C received only EN. The following evaluations were carried out: biochemical evaluation, which included serum albumin, prealbumin, transferrin, and urinary urea nitrogen evaluation every 20, 4, 8, and 0 days, respectively, and after 6 weeks at the end of the study, and anthropometric parameter measurement, which included BMI, mid-arm circumference, and dialysis malnutrition score (DMS). Results Serum albumin, prealbumin, BMI, and DMS significantly increased (P≤0.001) at the end in all groups. Serum transferrin increased only in groups A and B (P≤0.001), and there was a nonsignificant increase in group C (P≤0.05). No significant difference was found at the end between group A and group B as regards serum albumin (P=0.056), serum prealbumin (0.062), serum transferrin (0.0942), BMI (0.455), and DMS (P=0.840). Serum albumin, prealbumin, transferrin, and BMI showed a significant difference (P≤0.001) in group C at the end of the study in comparison with groups A and B with lower SD. Conclusion IDPN, either aromatic or branched amino acid, in addition to EN showed the same and greater improvement compared with patients who received only EN.