Before we answer that question, let’s first define Refeeding Syndrome (RF). RF is severe electrolyte and fluid shifts associated with metabolic abnormalities in malnourished patients undergoing refeeding, whether orally, enterally, or parenterally. The first documented cases were reported in 1949 when World War II soldiers were being rescued by allied troops, brought back and fed. Since that time, more research has been done on enteral and parenteral feeding demonstrating mortality and morbidity. Surprisingly, not many documented cases of mortality were shown in this research while the comorbidities resulted from electrolytes shift.

Although there are very limited cases of RF syndrome and ESRD, it is not something to ignore. Electrolyte shifts on dialysis is very common, further complicating identification of RF. Dialysis patients have higher calorie (25-35 kcal/kg) and protein (1.2-1.4 g/kg) requirements. They tend to be undernourished secondary to poor intake and dialysis related Protein-Energy Wasting (PEW). Although enteral nutrition is not rare in outpatient dialysis, oral and parenteral feeds tend to be a leading cause of RF with patients that have low albumins and are fed aggressively.

To avoid RF from Intradialytic Parenteral Nutrition (IDPN), Patient Care America starts each patient at a 50cc/hr rate for the first week and increases it to 100cc/hr during week two. By week three, we try to reach the patient’s goal rate, slowly easing them to goal while avoiding electrolyte shifts or adverse reactions.

What has been your experience with RF and IDPN?