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Kamyar Kalantarzadeh - One of the best experts on this subject based on the ideXlab platform.

  • diets and enteral supplements for improving outcomes in chronic kidney disease
    Nature Reviews Nephrology, 2011
    Co-Authors: Kamyar Kalantarzadeh, Csaba P. Kovesdy, Noel Cano, Klemens Budde, Charles Chazot, Robert H Mak, Rajnish Mehrotra, Dominic S Raj, Ashwini R Sehgal, Peter Stenvinkel
    Abstract:

    Protein-energy wasting (PEW), which is manifested by low serum levels of albumin or prealbumin, sarcopenia and weight loss, is one of the strongest predictors of mortality in patients with chronic kidney disease (CKD). Although PEW might be engendered by non-Nutritional conditions, such as inflammation or other comorbidities, the question of causality does not refute the effectiveness of dietary interventions and Nutritional support in improving outcomes in patients with CKD. The literature indicates that PEW can be mitigated or corrected with an appropriate diet and enteral Nutritional support that targets dietary protein intake. In-center meals or oral supplements provided during dialysis therapy are feasible and inexpensive interventions that might improve survival and quality of life in patients with CKD. Dietary requirements and enteral Nutritional support must also be considered in patients with CKD and diabetes mellitus, in patients undergoing peritoneal dialysis, renal transplant recipients, and in children with CKD. Adjunctive pharmacological therapies, such as appetite stimulants, anabolic hormones, and antioxidative or anti-inflammatory agents, might augment dietary interventions. Intraperitoneal or Intradialytic Parenteral Nutrition should be considered for patients with PEW whenever enteral interventions are not possible or are ineffective. Controlled trials are needed to better assess the effectiveness of in-center meals and oral supplements.

  • is there a role for Intradialytic Parenteral Nutrition a review of the evidence
    American Journal of Kidney Diseases, 2010
    Co-Authors: Ramanath Dukkipati, Kamyar Kalantarzadeh, Joel D Kopple
    Abstract:

    Protein-energy wasting (PEW) is highly prevalent in people with stages 4 and 5 chronic kidney disease, particularly in maintenance dialysis patients, and many indicators of PEW correlate strongly with mortality. Consequently, the causes, prevention, and treatment of PEW are active areas of investigation. A major cause of PEW is insufficient intake of nutrients, especially protein and energy (calories). Standard methods for increasing Nutritional intake in patients with chronic kidney disease with PEW include dietary counseling and use of food supplements. If nutrient intake does not increase sufficiently, tube feeding and total Parenteral Nutrition may be considered. For maintenance hemodialysis patients, Intradialytic Parenteral Nutrition (IDPN), an intravenous infusion of essential nutrients during hemodialysis treatments, may be used. Many studies have evaluated the effectiveness and safety of IDPN and show that IDPN has a good safety profile and also may improve protein-energy status. However, most studies have limitations in experimental design, such as small numbers of patients, lack of adequate controls, inclusion of patients without PEW, uncontrolled or unmonitored oral intake, nonrandomized design, or short duration. Additionally, most studies used Nutritional or inflammatory indicators, rather than the more important outcomes of morbidity, mortality, or quality of life. Thus, although IDPN may partially satisfy the Nutritional needs of maintenance hemodialysis patients who have or are at risk of PEW and who have substantial, but not adequate, protein and/or energy intake, longer term randomized prospective clinical trials with appropriate control groups are necessary to more definitively evaluate the clinical effectiveness and indications for IDPN.

  • narrative review is there a role for Intradialytic Parenteral Nutrition a review of the evidence
    2010
    Co-Authors: Ramanath Dukkipati, Kamyar Kalantarzadeh, Joel D Kopple
    Abstract:

    Protein-energy wasting (PEW) is highly prevalent in people with stages 4 and 5 chronic kidney disease, particularly in maintenance dialysis patients, and many indicators of PEW correlate strongly with mortality. Consequently, the causes, prevention, and treatment of PEW are active areas of investigation. A major cause of PEW is insufficient intake of nutrients, especially protein and energy (calories). Standard methods for increasing Nutritional intake in patients with chronic kidney disease with PEW include dietary counseling and use of food supplements. If nutrient intake does not increase sufficiently, tube feeding and total Parenteral Nutrition may be considered. For maintenance hemodialysis patients, Intradialytic Parenteral Nutrition (IDPN), an intravenous infusion of essential nutrients during hemodialysis treatments, may be used. Many studies have evaluated the effectiveness and safety of IDPN and show that IDPN has a good safety profile and also may improve protein-energy status. However, most studies have limitations in experimental design, such as small numbers of patients, lack of adequate controls, inclusion of patients without PEW, uncontrolled or unmonitored oral intake, nonrandomized design, or short duration. Additionally, most studies used Nutritional or inflammatory indicators, rather than the more important outcomes of morbidity, mortality, or quality of life. Thus, although IDPN may partially satisfy the Nutritional needs of maintenance hemodialysis patients who have or are at risk of PEW and who have substantial, but not adequate, protein and/or energy intake, longer term randomized prospective clinical trials with appropriate control groups are necessary to more definitively evaluate the clinical effectiveness and indications for IDPN. Am J Kidney Dis 55:352-364. © 2010 by the National Kidney Foundation, Inc.

  • 57 hypoalbuminemia severity predicts Intradialytic Parenteral Nutrition idpn effectiveness in hemodialysis patients
    American Journal of Kidney Diseases, 2008
    Co-Authors: Arezu Dezfuli, Deborah Scholl, Stanley M. Lindenfeld, Michelle Ricker, Kamyar Kalantarzadeh
    Abstract:

    Hypoalbuminemia Severity Predicts Intradialytic Parenteral Nutrition (IDPN) Effectiveness in Hemodialysis Patients Arezu Dezfuli, MD, Michelle Ricker, RD; Deborah Scholl, RD; Stanley M Lindenfeld, MD; and Kamyar Kalantar-Zadeh, MD PhD Harold Simmons Center for Kidney Disease Research& Epidemiology, Harbor-UCLA, Torrance, CA; and Pentec Health, Boothwyn, PA Background: Intradialytic Parenteral Nutrition (IDPN) is currently used infrequently to correct hypoalbuminemia in maintenance hemodialysis (MHD) patients (pts). Correcting hypoalbuminemia may significantly improve survival in MHD pts (Kalantar-Zadeh et al, NDT 2005; 20:1880-8). We hypothesized that IDPN responders, i.e., those whose baseline serum albumin [S-albumin] increased persistently during IDPN, have unique characteristics. Methods: In a recent cohort of MHD pts who had received IDPN through Pentec Health, predictors of IDPN response were examined using multivariate logistic regression. Results: A total of 196 MHD patients underwent IDPN for 5.8±2.4 mo between 2002 and 2006. Baseline serum albumin (2.68±0.47 g/dL) was lower in the IDPN responders than the non-responders (see table): MHD patients’ characteristics Responder (n=142) Nonresponder (n=54) p-value

Joel D Kopple - One of the best experts on this subject based on the ideXlab platform.

  • is there a role for Intradialytic Parenteral Nutrition a review of the evidence
    American Journal of Kidney Diseases, 2010
    Co-Authors: Ramanath Dukkipati, Kamyar Kalantarzadeh, Joel D Kopple
    Abstract:

    Protein-energy wasting (PEW) is highly prevalent in people with stages 4 and 5 chronic kidney disease, particularly in maintenance dialysis patients, and many indicators of PEW correlate strongly with mortality. Consequently, the causes, prevention, and treatment of PEW are active areas of investigation. A major cause of PEW is insufficient intake of nutrients, especially protein and energy (calories). Standard methods for increasing Nutritional intake in patients with chronic kidney disease with PEW include dietary counseling and use of food supplements. If nutrient intake does not increase sufficiently, tube feeding and total Parenteral Nutrition may be considered. For maintenance hemodialysis patients, Intradialytic Parenteral Nutrition (IDPN), an intravenous infusion of essential nutrients during hemodialysis treatments, may be used. Many studies have evaluated the effectiveness and safety of IDPN and show that IDPN has a good safety profile and also may improve protein-energy status. However, most studies have limitations in experimental design, such as small numbers of patients, lack of adequate controls, inclusion of patients without PEW, uncontrolled or unmonitored oral intake, nonrandomized design, or short duration. Additionally, most studies used Nutritional or inflammatory indicators, rather than the more important outcomes of morbidity, mortality, or quality of life. Thus, although IDPN may partially satisfy the Nutritional needs of maintenance hemodialysis patients who have or are at risk of PEW and who have substantial, but not adequate, protein and/or energy intake, longer term randomized prospective clinical trials with appropriate control groups are necessary to more definitively evaluate the clinical effectiveness and indications for IDPN.

  • narrative review is there a role for Intradialytic Parenteral Nutrition a review of the evidence
    2010
    Co-Authors: Ramanath Dukkipati, Kamyar Kalantarzadeh, Joel D Kopple
    Abstract:

    Protein-energy wasting (PEW) is highly prevalent in people with stages 4 and 5 chronic kidney disease, particularly in maintenance dialysis patients, and many indicators of PEW correlate strongly with mortality. Consequently, the causes, prevention, and treatment of PEW are active areas of investigation. A major cause of PEW is insufficient intake of nutrients, especially protein and energy (calories). Standard methods for increasing Nutritional intake in patients with chronic kidney disease with PEW include dietary counseling and use of food supplements. If nutrient intake does not increase sufficiently, tube feeding and total Parenteral Nutrition may be considered. For maintenance hemodialysis patients, Intradialytic Parenteral Nutrition (IDPN), an intravenous infusion of essential nutrients during hemodialysis treatments, may be used. Many studies have evaluated the effectiveness and safety of IDPN and show that IDPN has a good safety profile and also may improve protein-energy status. However, most studies have limitations in experimental design, such as small numbers of patients, lack of adequate controls, inclusion of patients without PEW, uncontrolled or unmonitored oral intake, nonrandomized design, or short duration. Additionally, most studies used Nutritional or inflammatory indicators, rather than the more important outcomes of morbidity, mortality, or quality of life. Thus, although IDPN may partially satisfy the Nutritional needs of maintenance hemodialysis patients who have or are at risk of PEW and who have substantial, but not adequate, protein and/or energy intake, longer term randomized prospective clinical trials with appropriate control groups are necessary to more definitively evaluate the clinical effectiveness and indications for IDPN. Am J Kidney Dis 55:352-364. © 2010 by the National Kidney Foundation, Inc.

  • mccollum award lecture 1996 protein energy malNutrition in maintenance dialysis patients
    The American Journal of Clinical Nutrition, 1997
    Co-Authors: Joel D Kopple
    Abstract:

    There is a high prevalence of protein-energy malNutrition in patients with chronic renal failure who are undergoing maintenance dialysis therapy. The high prevalence of malNutrition is a potentially serious problem because indexes of protein-energy malNutrition are powerful predictors of mortality in maintenance dialysis patients. Although the data do not prove that improving Nutritional intake will reduce mortality, nonrandomized studies suggest that provision of addition amino acids and energy to such patients is associated with reduced mortality. There are many causes for protein-energy malNutrition in maintenance dialysis patients. Among the three most important factors are the Nutritional status of the patient before commencing dialysis therapy, inadequate protein and energy intakes after they become dialysis patients, and acute and chronic illnesses. Improving the nutrient intake of maintenance dialysis patients is a challenging task because most chronic renal failure patients with malNutrition are anorectic, and dietary counseling has had limited success at increasing their nutrient intake. Other methods for improving Nutritional status in adults, infants, and children with chronic renal failure that have been tried with varying degrees of success include increasing the dose of dialysis and the use of food supplements and tube feeding. Less well-proven techniques for the treatment of protein-energy malNutrition include Intradialytic Parenteral Nutrition. The use of appetite stimulants and such growth factors as rhGH and rhIGF-I are still in the experimental stage.

Alan H Lau - One of the best experts on this subject based on the ideXlab platform.

  • malNutrition in patients undergoing hemodialysis is Intradialytic Parenteral Nutrition the answer
    Pharmacotherapy, 2004
    Co-Authors: Priscilla How, Alan H Lau
    Abstract:

    Patients with end-stage renal disease often experience malNutrition as a result of decreased dietary intake; inadequate dialysis; loss of nutrients into the dialysate; abnormal protein, carbohydrate, and lipid metabolism; and concomitant diseases, which may contribute to an increase in morbidity and mortality. Intradialytic Parenteral Nutrition (IDPN) is being used to improve Nutritional status, in conjunction with other methods of Nutritional supplementation. The biggest advantage of IDPN is probably its convenience since it is administered during dialysis treatment and thus does not require additional clinic visits or prolonged dialysis time. Although IDPN has several disadvantages, its ability to improve Nutritional status and reduce morbidity and mortality in patients with end-stage renal disease is promising. Well-designed, large-scale, prospective studies are required to confirm its beneficial effects.

Helmut Mann - One of the best experts on this subject based on the ideXlab platform.

  • Intradialytic Parenteral Nutrition in maintenance hemodialysis patients suffering from protein energy wasting results of a multicenter open prospective randomized trial
    Clinical Nutrition, 2017
    Co-Authors: Tobias A Marsen, Justinus Beer, Helmut Mann
    Abstract:

    Summary Background & aims Protein-energy wasting (PEW) is increasingly becoming a clinical problem in maintenance hemodialysis patients and guidelines call for Nutritional interventions. Serum prealbumin (transthyretin) represents a critical Nutritional marker positively correlated with patient survival and negatively correlated with morbidity. Nutritional counseling, oral supplementation as well as Intradialytic Parenteral Nutrition (IDPN) are recommended to fight PEW, however clinical trials on their use are scarce. Methods We conducted a prospective, multicenter, randomized, open-label, controlled, parallel-group Phase IV clinical trial in 107 maintenance hemodialysis patients suffering from PEW to assess the impact of IDPN on prealbumin and other biochemical and clinical parameters reflecting Nutritional status. Patients randomized to the intervention group received standardized Nutritional counseling plus IDPN three times weekly over 16 weeks followed by a treatment-free period of 12 weeks. The control group received standardized Nutritional counseling only. Main trial inclusion criteria included moderate to severe malNutrition (SGA score B or C), maintenance hemodialysis therapy (3 times per week) for more than six months, and presence of two out of the following three criteria: albumin Changes in serum prealbumin, albumin, transferrin, phase angle alpha, subjective global assessment (SGA) score and health-related quality of life using the 12-item short form health survey (SF-12) were investigated. Results IDPN significantly increased prealbumin (p  30 mg/L at week 16 (48.7% vs. 31.8%). Prealbumin response to IDPN therapy was more prominent in patients suffering from moderate malNutrition (SGA score B) compared to patients with severe malNutrition (SGA score C). Conclusions The results of this trial demonstrate for the first time that IDPN therapy, given three times weekly in a 16-week short-term intervention, results in a statistically significant and clinically relevant increase in mean serum prealbumin, a surrogate marker for outcome and survival in hemodialysis patients suffering from PEW, and is superior to Nutritional counseling. Clinical trial registry: www.clinicaltrials.gov (NCT00501956).

Raymond M. Hakim - One of the best experts on this subject based on the ideXlab platform.

  • Intradialytic Parenteral Nutrition improves protein and energy homeostasis in chronic hemodialysis patients
    Journal of Clinical Investigation, 2002
    Co-Authors: Lara B Pupim, Raymond M. Hakim, Paul J Flakoll, John R Brouillette, Deanna K Levenhagen, Alp T Ikizler
    Abstract:

    Decreased dietary protein intake and hemodialysis-associated protein catabolism are among several factors that predispose chronic hemodialysis (CHD) patients to protein calorie malNutrition. Since attempts to increase protein intake by dietary counseling are usually ineffective, Intradialytic Parenteral Nutrition (IDPN) has been proposed as a potential therapeutic approach in malnourished CHD patients. In this study, we examined protein and energy homeostasis during hemodialysis in seven CHD patients at two separate hemodialysis sessions, with and without IDPN administration. Patients were studied 2 hours before, during, and 2 hours following a hemodialysis session, using a primed constant infusion of L-(1-(13)C) leucine and L-(ring-(2)H(5)) phenylalanine. Our results showed that IPDN promoted a large increase in whole-body protein synthesis and a significant decrease in whole-body proteolysis, along with a significant increase in forearm muscle protein synthesis. The net result was a change from an essentially catabolic state to a highly positive protein balance, both in whole-body and forearm muscle compartments. We conclude that the provision of calories and amino acids during hemodialysis with IDPN acutely reverses the net negative whole-body and forearm muscle protein balances, demonstrating a need for long-term clinical trials evaluating IDPN in malnourished CHD patients.

  • the potential of Intradialytic Parenteral Nutrition a review
    Mineral and Electrolyte Metabolism, 1999
    Co-Authors: Lara B Pupim, Pamela S Kent, Raymond M. Hakim
    Abstract:

    MalNutrition is common in chronic hemodialysis (CHD) patients and is strongly related to increased morbidity and mortality. Among the various approaches to treat malNutrition in this patient population, Intradialytic Parenteral Nutrition (IDPN) is the treatment of choice for a small but important percentage of malnourished CHD patients. However, the new revised policies relating to IDPN reimbursement by Medicare in the US have made it very difficult to qualify patients for this potentially useful therapy. This restrictive policy was adopted mainly because there are no clear data that support IDPN use or efficacy. Studies to date in the literature do not provide clear documentation of the benefits of IDPN or their cost-effectiveness. The purpose of this review is to critically evaluate studies relating to the use of IDPN as a potential therapy to treat malNutrition in CHD patients and to discuss potential trials to prove its cost-effectiveness.

  • proposed clinical trials in the evaluation of Intradialytic Parenteral Nutrition
    American Journal of Kidney Diseases, 1999
    Co-Authors: Raymond M. Hakim
    Abstract:

    New revised policies relating to Intradialytic Parenteral Nutrition (IDPN) reimbursement by Medicare have made it difficult, if not impossible, to qualify malnourished hemodialysis patients for this potentially useful therapy. These policies were adopted by Medicare because of a lack of studies that provide clear documentation of the medical benefits of IDPN or their cost-effectiveness. We propose a limited study of the role of IDPN with and without anabolic growth factors to improve predefined Nutritional parameters and document its cost-effectiveness by monitoring hospitalization and mortality. The proposed study will be multicenter, prospective, limited to severely malnourished patients, and will include a control group that would receive standard of care.

  • Interventions to treat malNutrition in dialysis patients : the role of the dose of dialysis, Intradialytic Parenteral Nutrition, and growth hormone
    American journal of kidney diseases : the official journal of the National Kidney Foundation, 1995
    Co-Authors: T. Alp Ikizler, Rebecca L. Wingard, Raymond M. Hakim
    Abstract:

    . Protein and calorie malNutrition often starts before initiation of dialysis, and reflects the anorexia and the catabolic state of chronic renal failure. In the face of inadequate dialysis, which perpetuates the uremic state, malNutrition often worsens. Several studies, though not all, suggest that optimal dialysis improves Nutritional status of dialysis patients. Such optimal dialysis now must include the use of biocompatible membranes to deliver Kt/V > 1.4 (urea reduction ratio > 65%). Additional interventions can include the use of enteral or intravenous hyperalimentation, and recombinant growth factors such as growth hormone or insulin-like growth factor-1. Importantly, studies to document the improvement in the morbidity and mortality of patients with these interventions are still needed and require large multicenter trials.

  • the effects of recombinant human growth hormone and Intradialytic Parenteral Nutrition in malnourished hemodialysis patients
    American Journal of Kidney Diseases, 1993
    Co-Authors: Gerald Schulman, Rebecca L. Wingard, Rita Lynn Hutchison, Patricia Lawrence, Raymond M. Hakim
    Abstract:

    MalNutrition in hemodialysis patients is associated with increased morbidity and mortality. The use of Intradialytic Parenteral Nutrition (IDPN) to improve Nutritional parameters has been shown to be of limited benefit in most studies. We studied the use of recombinant human growth hormone (rHuGH) in potentiating the effects of IDPN in seven hemodialysis patients dialyzed with a Kt/V of 1.03 ± 0.11 (mean ± SEM), but with evidence of malNutrition: albumin, 3.2 ± 0.18 g/dL; transferrin, 215 ± 30 mg/dL; insulin-like growth factor-1 (IGF-1),115 ± 19 ng/mL, protein catabolic rate (PCR), 0.70 ± 0.05 g/kg/d; and weight, 12.3% ± 4.0% below ideal body weight. During 6 weeks of IDPN, resulting in an additional 18 ± 4 kcal and 0.69 ± 0.03 g of protein/kg body weight per dialysis session, albumin concentration increased to 3.5 ± 0.14 g/dL (compared with baseline, P = NS), transferrin increased to 279 ± 36 mg/dL ( P P = NS), and PCR increased to 0.81 ± 0.04 g/kg/d ( P = NS). During the next 6 weeks, IDPN administration was continued and rHuGH, at a dose of 5 mg subcutaneously during each dialysis, was added to the regimen. This resulted in an increase in albumin concentration to 3.8 ± 0.08 g/dL ( P P = NS compared with end of IDPN phase), and an increase in IGF-1 to 212 ± 45 ng/mL ( P = 0.05 compared with end of IDPN phase). In addition, during the rHuGH administration phase, PCR decreased from 0.81 ± 0.04 g/kg/d at the end of the IDPN phase to 0.67 ± 0.03 g/kg/d, consistent with a decrease in Intradialytic urea appearance. There were no statistically significant changes in anthropometric parameters during the study period. We conclude that the addition of rHuGH to an IDPN regimen potentiates the effects of IDPN and may improve malNutrition parameters in hemodialysis patients. Nevertheless, in the absence of a larger population and a placebo-controlled randomized designed study, these results should be considered as preliminary and in need of further confirmation.