Malays. Appl. Biol. (2018) 47(3): 1–11
ENABLING INTRADIALYTIC PARENTERAL NUTRITION IN
MAINTENANCE HAEMODIALYSIS PATIENTS IN MALAYSIA:
THE WHAT, WHO AND HOW SCENARIOS OF
IMPLEMENTATION?
SADU SINGH, B.K.1, ABDUL GAFOR, A.H.2, FIACCADORI, E.3 and KARUPAIAH, T.4*
1Nutrition Programme, Faculty of Health Sciences, National University of Malaysia,
Kuala Lumpur, Malaysia
2Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre,
Cheras, Kuala Lumpur, Malaysia
3Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine,
University of Parma, Parma, Italy
4School of BioSciences, Faculty of Health & Medical Science, Taylor’s University Lakeside Campus,
Selangor, Malaysia
*E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Accepted 22 June 2018, Published online 30 June 2018
ABSTRACT
In Malaysia, prevalence of end stage renal disease patients on haemodialysis has risen exponentially over the last 2 decades and malnutrition is significant in this population. In particular, protein energy wasting (PEW) is highly prevalent and associated with increased mortality and complications. Inadequate oral intake and poor appetite are implicated issues in the etiology of PEW. Intradialytic Parenteral Nutrition (IDPN) has been recommended by the International Society of Renal Nutrition and Metabolism as a treatment modality when dietary counselling and oral nutrition supplements fail to treat PEW in dialysis patients. IDPN does not require an additional infusion access and allows the delivery of nutrients during haemodialysis. IDPN practice protocols are now placed at different regions in the world. However, despite improved patient metabolic and nutritional status with IDPN, evidence linking IDPN with reduction in hospitalisation rates and mortality risk is limited. This review discusses IDPN composition and prescription, IDPN patient selection criteria, current available IDPN practice guidelines and the delivery of IDPN to haemodialysis patients. We conclude that IDPN is a potential adjunctive treatment strategy in the outpatient setting which is safe and efficacious for malnourished haemodialysis patients, when intensive dietary counselling and oral supplementation are compromised.
Key words: Haemodialysis, Protein Energy Wasting, Intradialytic Parenteral Nutrition
