Intradialytic Parenteral Nutrition during In-Center Hemodialysis of Patients Leads to Increase in Albumin without Compromising Safety

Key Points Intradialytic parenteral nutrition (IDPN) is a safe therapy with improvement in serum albumin levels, a marker of morbidity and mortality in patients on hemodialysis. Clinically significant improvements in albumin levels can be observed within 2 months of initiation of IDPN use. Research on IDPN is needed to identify benefits of its use in subgroups and on important clinical outcomes ( i.e ., quality of life, hospitalization, and mortality). Background Albumin is an established survival surrogate in dialysis. We evaluated the effect of intradialytic parenteral nutrition (IDPN) on albumin levels in patients with ESKD undergoing in-center hemodialysis and determined characteristics associated with response to IDPN treatment. Methods We conducted a 5-year (May 2018–April 2023) retrospective chart review of 2270 patients on in-center hemodialysis from 1039 dialysis centers, in 43 states and the District of Columbia, who received concurrent IDPN treatment three times per week. Patients were aged 18 years and older (mean 69.1 years) with albumin levels <4.0 g/dl (mean 3.11 g/dl) and were on hemodialysis for more than 6 months (mean 3.7 years). Other criteria included unintentional weight loss (≥5%/3 months) and/or body mass index below 20 kg/m 2 . The coprimary end points included mean change in albumin levels from baseline to month 6 of IDPN therapy and percentage of patients with a clinically significant change in albumin levels, defined as ≥0.2 g/d with a P < 0.05. Each patient studied was their own control. We used Kaplan–Meier curves to evaluate the time to positive IDPN response. Two-sample t tests for continuous variables and Chi-square tests for categorical variables were used to determine whether certain defined patient characteristics were associated with a positive response to IDPN therapy. Results One thousand nine hundred forty-six eligible patients consented to being evaluated. Baseline demographics include 50.9% female and 49.1% male with a mean albumin of 3.11 g/dl. Evaluable data at 6 months were available for 73% of patients. Mean change in albumin levels from baseline to 6 months after initiation of IDPN therapy was 0.330 g/dl; 82.0% of patients achieved ≥0.2-g/dl increase in albumin level within those 6 months. Younger age and lower baseline albumin levels were significantly and independently associated with a higher and more rapid significant rise, P < 0.05, in albumin levels. While receiving IDPN, fewer than 8% of patients reported minimal and treatable side effects. Conclusions IDPN is a safe and effective therapy resulting in clinically significant improvement in serum albumin levels. Further research on associated outcomes and quality-of-life data is needed.