Intradialytic parenteral nutrition in Europe: a survey among clinical practitioners

Abstract

Background: Intradialytic parenteral nutrition (IDPN) is recommended for patients on hemodialysis (HD) with protein–energy wasting (PEW) who cannot meet nutritional needs through oral or enteral intake. However, its use is highly variable and overall, this option is underutilized. We surveyed European practitioners to investigate barriers, facilitators and key factors related to IDPN implementation. Methods: We developed and distributed an online survey containing 27 questions about practice patterns of IDPN to the members of the European Renal Association (ERA) and other European Societies of Nutrition or Nephrology. Results: A total of 208 replies from practitioners from 30 countries were received; most respondents were aged 25–54 years (73.2%), and were female (68.4%). Only 23% of respondents frequently prescribed IDPN, 43% rarely used it, and 34% had no experience. Costs, perceived non-efficacy, lack of protocols, and staff inexperience were the main barriers for prescribing IDPN. The main indications were failure to improve spontaneous oral intake, malabsorption, and unintentional weight loss. The outcomes were mainly monitored through changes in serum albumin and post dialysis weight. The most commonly reported clinical contraindications were the risk of volume overload, hepatic dysfunction and vascular access problems. Conclusions: This survey reports low use of IDPN by European healthcare professionals. To exploit the potential of this treatment there is a need for educational programs regarding implementation and monitoring of IDPN.