Intradialytic Parenteral Nutrition (IDPN) and Intraperitoneal Nutrition (IPN) are therapies that have been used for decades to treat malnourished dialysis patients. There is clinical evidence that supports its safety and efficacy. Originally IDPN was given in high volume of upwards of 2000 mL, and contained a large volume of dextrose. Due to the high incidence of diabetes in patients with renal failure, administering IDPN required blood glucose checks pre, during and post dialysis, and insulin if the patient required it. After a consistent infusion of high amounts of dextrose over the course of 4 hours patients would experience post dialysis hypoglycemia due to the pancreas continuing to produce insulin.
Although IDPN has evolved and has evidence based positive outcomes, medical staff are still sometimes reluctant to initiate IDPN (or amino acid therapy) until serum albumin drops beyond severe malnutrition criteria. Our NutriRite™ IDPN therapy has evolved to using just enough dextrose for the liver to metabolize. This has enabled us to reduce the volume of IDPN to around 600 mL while achieving protein KDOQI goals of 1.2-1.4 grams of protein per kg of patient’s body weight. Due to the marginal amounts of dextrose (roughly 30-60 gm), blood glucose checks are done solely at the discretion of the clinical staff and are not required.
