In 2019, 62,275 people were using peritoneal dialysis (PD) to manage their end-stage renal disease (ESRD). In the coming years, that number will likely increase as more patients are encouraged to use home modalities instead of the standard in-center hemodialysis (ICHD).
The shift to focusing more on PD has major benefits for patients and healthcare providers alike. This includes better health outcomes, more independence, and lower healthcare costs. However, PD is not without its challenges in large part due to the standard dialysate solution that is used to perform treatments.
With the dextrose-based standard solution patients run the risk of developing malnutrition, hyperglycemia, and eventual loss of the peritoneal membrane because standard solutions are not very biocompatible.
In the U.S. we have limited but viable options to replace a portion of the standard solution in a patient’s regimen. The most popular alternative by default is Icodextrin, an isosmotic solution with a low carbohydrate load. This solution is typically reserved for patients with diabetes or transport issues and may be associated with better preservation of the peritoneal membrane.
Icodextrin, however, does not address the issue of malnutrition which can occur in up to 50% of patients on PD.
Enter intraperitoneal nutrition, also called IPN.
IPN is similar to other PD solutions used in countries outside the U.S. and is comprised of a combination of amino acids and dextrose. For a long a time, we’ve known that amino acid-containing solutions can deliver valuable protein into the body in excess of the losses seen when performing peritoneal dialysis. This goes a long way to combat and prevent malnutrition.
Additional benefits result from the way IPN is compounded; the dextrose content never exceeds that of a 1.5% dextrose solution. The higher the dextrose content in the solution, the more dextrose is available for absorption and it becomes more damaging to the peritoneal membrane. Keeping the solution to 1.5% dextrose can help reduce the incidence of hyperglycemia and may be less harsh on the peritoneal membrane.
There are common misconceptions that IPN will add additional fluid and negatively impact Kt/V, none of which is born out in the research. IPN mimics the same ultrafiltration as standard dextrose-based solution because amino acids are also considered hyperosmotic. This means no additional fluid is added to the patient and they will continue to draw fluid and waste products out of the body when they dialyze with IPN.
Science is still working to create a perfect solution to the loss of kidney function. PD offers one option that allows patients to maintain an independent lifestyle and avoid some of the challenges observed with ICHD. To keep patients on PD, we need to explore options for dialysis solutions that keep them feeling healthy and strong. IPN can be part of that solution.
If you are considering IPN for your PD patients and would like to learn more about Patient Care America’s NutriRite IPN for Home, visit our website and get in touch at firstname.lastname@example.org or with your local Nutrition Therapy Consultant.
To learn more about IDPN and IPN therapies for dialysis patients, logon to our clinician portal where you’ll find more clinician-oriented content as well as patient educational and downloadable handouts:
- Kiebalo, T., Holotka, J., Habura, I., & Pawlaczyk, K. (2020). Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition. Nutrients, 12(6), 1715. https://doi.org/10.3390/nu12061715
- Roumeliotis, S., Dounousi, E., Salmas, M., Eleftheriadis, T., & Liakopoulos, V. (2020). Unfavorable Effects of Peritoneal Dialysis Solutions on the Peritoneal Membrane: The Role of Oxidative Stress. Biomolecules, 10(5), 768. https://doi.org/10.3390/biom10050768
- Morelle, J., Sow, A., Fustin, C. A., Fillée, C., Garcia-Lopez, E., Lindholm, B., … & Devuyst, O. (2018). Mechanisms of crystalloid versus colloid osmosis across the peritoneal membrane. Journal of the American Society of Nephrology, 29(7), 1875-1886.
- Bartosova, M., & Schmitt, C. P. (2019). Biocompatible Peritoneal Dialysis: The Target Is Still Way Off. Frontiers in physiology, 9, 1853. https://doi.org/10.3389/fphys.2018.01853
- Cho, Y., Badve, S. V., Hawley, C. M., Wiggins, K., & Johnson, D. W. (2012). Biocompatible peritoneal dialysis fluids: clinical outcomes. International journal of nephrology, 2012, 812609. https://doi.org/10.1155/2012/812609
- Salzer W. L. (2018). Peritoneal dialysis-related peritonitis: challenges and solutions. International journal of nephrology and renovascular disease, 11, 173–186. https://doi.org/10.2147/IJNRD.S123618
- United States Renal Data System. 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2018.
- Park, M. S., Choi, S. R., Song, Y. S., Yoon, S. Y., Lee, S. Y., & Han, D. S. (2006). New insight of amino acid-based dialysis solutions. Kidney International, 70, S110-S114.
- Asola, M., Virtanen, K., Någren, K., Helin, S., Taittonen, M., Kastarinen, H., … & Nuutila, P. (2008). Amino-acid-based peritoneal dialysis solution improves amino-acid transport into skeletal muscle. Kidney International, 73, S131-S136.