The new KDOQI 2020 Updates were recently published after months of exhausting work done by an interdisciplinary team tasked with pouring over all the available literature in order to provide more guidance to the practice of renal nutrition. Kudos to them for all they’ve done, as this update was really needed and will be so helpful for all practitioners.

At Patient Care America, we were thrilled to see positive momentum in the discussion on the use of IDPN therapy in clinical practice. If you are unfamiliar, Patient Care America provides intradialytic parenteral nutrition (IDPN) and intraperitoneal nutrition (IPN) therapies for patients with end-stage kidney disease (ESKD) on dialysis. These therapies are non-invasive infusions of amino acids and dextrose to help boost a patient’s nutrition, to help increase albumin levels, to help prevent and/or treat protein-energy wasting (PEW), and to ultimately keep patients feeling well and out of the hospital. Our therapies are meant to be used in conjunction with nutrition counseling and regular dietary protein intake with or without oral nutrition supplements.

When the first KDOQI Guidelines were released in 2000, the methods used to evaluate research were limited so recommendations were given a designation of Evidence, meaning there was research to support the recommendation; or Opinion, meaning there was inadequate research available. IDPN fell under a mixed category of Evidence and Opinion at that time.

The new KDOQI Guidelines: 2020 Update uses a stronger ranking system called GRADE criteria which assesses quality of evidence and strength of recommendations.

While 47% of statements in the new KDOQI Updates were still Opinions, again meaning there was not enough or there was poor-quality evidence to support the recommendations; IDPN received a rare 2C Grade. The full statement on IDPN reads “In adults with CKD with protein-energy wasting, we suggest a trial of IDPN for CKD 5D on MHD patients (2C), to improve and maintain nutritional status if nutritional requirements cannot be met with existing oral and enteral intake.”

It is promising to see such an improvement in the recommendation for IDPN and we at Patient Care America look forward to continuing to build the evidence for this therapy that contributes to keeping patients out of the hospital and feeling better.

About the Author

Maiya Slusser, MS, RDN, CD, CNSC has been a dietitian for nearly a decade and serves as the Renal Therapy Educator for Patient Care America. First and foremost, as a clinician, she is dedicated to helping people improve their quality of life through improved nutrition. Currently she does this by digging into the research, looking at all the nitty gritty details related to nutrition, the body, and renal disease; and brings all that information to renal healthcare professionals to improve their nutrition practice and provide continuing education hours.

This blog is intended to supplement the free monthly CEU webinars hosted by Patient Care America. It’s an avenue to provide more insight and education into topics that may not be fully explored in a 1-hour presentation.