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Intradialytic Parenteral Nutrition Does Not Improve Survival in Malnourished Hemodialysis Patients: A 2-Year Multicenter, Prospective, Randomized Study

Noël J.M. Cano^*, Denis Fouque, Hubert Roth, Michel Aparicio, Raymond Azar^||, Bernard Canaud^¶, Philippe Chauveau^**, Christian Combe^,**, Maurice Laville, Xavier M. Leverve the French Study Group for Nutrition in Dialysis

^* Service d’Hépatogastroenterologie et Nutrition, Clinique Résidence du Parc, Marseille, Service de Néphrologie, Hôpital Edouard Herriot, Lyon, INSERM-E0221 Bioénergétique Fondamentale et Appliquée, Grenoble, Université Bordeaux2 and CHU de Bordeaux and ^** AURAD Aquitaine, Bordeaux, ^|| Service de Néphrologie, Centre Hospitalier, Dunkerque, and ^¶ Service de Néphrologie, Hôpital Lapeyronnie, Montpellier, France

Correspondence: Dr. Noël J.M. Cano, CRNH Auvergne, 58 Rue Montalembert, BP 321, 63009 Clermont-Ferrand cedex 1, France. Phone: +33-4-7360-8250; Fax: +33-4-7360-8255; E-mail: ncano{at}clermont.inra.fr

Received for publication February 11, 2007. Accepted for publication May 3, 2007.

Although intradialytic parenteral nutrition (IDPN) is a method used widely to combat protein-calorie malnutrition in hemodialysis patients, its effect on survival has not been thoroughly studied. We conducted a prospective, randomized trial in which 186 malnourished hemodialysis patients received oral nutritional supplements with or without 1 year of IDPN. IDPN did not improve 2-year mortality (primary end point), hospitalization rate, Karnofsky score, body mass index, or laboratory markers of nutritional status. Instead, both groups demonstrated improvement in body mass index and the nutritional parameters serum albumin and prealbumin (P < 0.05). Multivariate analysis showed that an increase in prealbumin of >30 mg/L within 3 months, a marker of nutritional improvement, independently predicted a 54% decrease in 2-year mortality, as well as reduced hospitalizations and improved general well-being as measured by the Karnofsky score. Therefore, although we found no definite advantage of adding IDPN to oral nutritional supplementation, this is the first prospective study demonstrating that an improvement in prealbumin during nutritional therapy is associated with a decrease in morbidity and mortality in malnourished hemodialysis patients.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673