Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot study
Abstract Background Standard amino acid solutions have recently been removed from the contraindications for use in dialysis patients in Japan. However, the details of their safety and efficacy in these patients are still not known. In this study, we investigated the safety and efficacy of intradialy...
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | Renal Replacement Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41100-022-00432-5 |
| _version_ | 1811274801589780480 |
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| author | Ryota Yasukawa Michihiro Hosojima Hideyuki Kabasawa Aya Takeyama Daisuke Ugamura Yoshiki Suzuki Akihiko Saito Ichiei Narita |
| author_facet | Ryota Yasukawa Michihiro Hosojima Hideyuki Kabasawa Aya Takeyama Daisuke Ugamura Yoshiki Suzuki Akihiko Saito Ichiei Narita |
| author_sort | Ryota Yasukawa |
| collection | DOAJ |
| description | Abstract Background Standard amino acid solutions have recently been removed from the contraindications for use in dialysis patients in Japan. However, the details of their safety and efficacy in these patients are still not known. In this study, we investigated the safety and efficacy of intradialytic parenteral nutrition (IDPN) using ENEFLUID® injection containing standard amino acids, glucose, electrolytes, fats, and water-soluble vitamins in maintenance hemodialysis patients with malnutrition. Methods This clinical trial was designed as a multicenter, prospective, non-randomized, open-label, single-arm, observational pilot study. The participants were patients on maintenance hemodialysis who were in the nutritional high-risk group according to the Nutritional Risk Index for Japanese Hemodialysis Patients. One bag of ENEFLUID® injection was administered during every hemodialysis session for 12 weeks. The primary endpoint was change in serum transthyretin levels between before and after the 12-week period. As safety endpoints, we evaluated changes in body fluid volume and blood biochemical tests, including blood urea nitrogen and electrolytes, as well as blood glucose variability using flash glucose monitoring (FGM). Results The mean age and body mass index of the 13 participants were 79.0 ± 10.7 years and 18.0 ± 1.7 kg/m2, respectively. No significant changes were observed in nutritional parameters, including serum transthyretin, between before and after the start of the study. After IDPN initiation, there was no obvious fluid overload or significant changes in blood biochemical tests, including electrolytes, and the treatment could be safely continued for 12 weeks. In the FGM analysis, asymptomatic hypoglycemia during hemodialysis was observed at the beginning of the study, but there was a trend toward improvement after 12 weeks (area over the curve < 70 mg/dl per dialysis session: 747.5 ± 1333.9 to 21.6 ± 54.3, P = 0.09). Conclusions IDPN using ENEFLUID® injection can be safely continued, although it does not significantly improve markers of nutritional status. It also showed the potential to ameliorate asymptomatic hypoglycemia during hemodialysis sessions. More detailed studies of the improvement in nutritional indicators are needed. Trial registration: This study was registered with the University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) on May 9, 2021 (registration ID, UMIN000044051). |
| first_indexed | 2024-04-12T23:26:39Z |
| format | Article |
| id | doaj.art-04a7be972ed4426b8b3b49bbe9aa3006 |
| institution | Directory Open Access Journal |
| issn | 2059-1381 |
| language | English |
| last_indexed | 2024-04-12T23:26:39Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Renal Replacement Therapy |
| spelling | doaj.art-04a7be972ed4426b8b3b49bbe9aa30062022-12-22T03:12:24ZengBMCRenal Replacement Therapy2059-13812022-09-01811810.1186/s41100-022-00432-5Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot studyRyota Yasukawa0Michihiro Hosojima1Hideyuki Kabasawa2Aya Takeyama3Daisuke Ugamura4Yoshiki Suzuki5Akihiko Saito6Ichiei Narita7Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental SciencesDepartment of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental SciencesDepartment of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental SciencesDepartment of Nephrology, Niigata Saiseikai Sanjo HospitalDivision of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental SciencesDivision of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental SciencesDepartment of Applied Molecular Medicine, Kidney Research Center, Niigata University Graduate School of Medical and Dental SciencesDivision of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental SciencesAbstract Background Standard amino acid solutions have recently been removed from the contraindications for use in dialysis patients in Japan. However, the details of their safety and efficacy in these patients are still not known. In this study, we investigated the safety and efficacy of intradialytic parenteral nutrition (IDPN) using ENEFLUID® injection containing standard amino acids, glucose, electrolytes, fats, and water-soluble vitamins in maintenance hemodialysis patients with malnutrition. Methods This clinical trial was designed as a multicenter, prospective, non-randomized, open-label, single-arm, observational pilot study. The participants were patients on maintenance hemodialysis who were in the nutritional high-risk group according to the Nutritional Risk Index for Japanese Hemodialysis Patients. One bag of ENEFLUID® injection was administered during every hemodialysis session for 12 weeks. The primary endpoint was change in serum transthyretin levels between before and after the 12-week period. As safety endpoints, we evaluated changes in body fluid volume and blood biochemical tests, including blood urea nitrogen and electrolytes, as well as blood glucose variability using flash glucose monitoring (FGM). Results The mean age and body mass index of the 13 participants were 79.0 ± 10.7 years and 18.0 ± 1.7 kg/m2, respectively. No significant changes were observed in nutritional parameters, including serum transthyretin, between before and after the start of the study. After IDPN initiation, there was no obvious fluid overload or significant changes in blood biochemical tests, including electrolytes, and the treatment could be safely continued for 12 weeks. In the FGM analysis, asymptomatic hypoglycemia during hemodialysis was observed at the beginning of the study, but there was a trend toward improvement after 12 weeks (area over the curve < 70 mg/dl per dialysis session: 747.5 ± 1333.9 to 21.6 ± 54.3, P = 0.09). Conclusions IDPN using ENEFLUID® injection can be safely continued, although it does not significantly improve markers of nutritional status. It also showed the potential to ameliorate asymptomatic hypoglycemia during hemodialysis sessions. More detailed studies of the improvement in nutritional indicators are needed. Trial registration: This study was registered with the University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) on May 9, 2021 (registration ID, UMIN000044051).https://doi.org/10.1186/s41100-022-00432-5HypoglycemiaIntradialytic parenteral nutritionNutritional Risk Index for Japanese Hemodialysis PatientsMalnutritionTransthyretin |
| spellingShingle | Ryota Yasukawa Michihiro Hosojima Hideyuki Kabasawa Aya Takeyama Daisuke Ugamura Yoshiki Suzuki Akihiko Saito Ichiei Narita Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot study Renal Replacement Therapy Hypoglycemia Intradialytic parenteral nutrition Nutritional Risk Index for Japanese Hemodialysis Patients Malnutrition Transthyretin |
| title | Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot study |
| title_full | Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot study |
| title_fullStr | Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot study |
| title_full_unstemmed | Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot study |
| title_short | Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot study |
| title_sort | intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition a multicenter pilot study |
| topic | Hypoglycemia Intradialytic parenteral nutrition Nutritional Risk Index for Japanese Hemodialysis Patients Malnutrition Transthyretin |
| url | https://doi.org/10.1186/s41100-022-00432-5 |
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