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Other Hospital Pharmacy topics (including: medical devices)
Compliance with Spanish and international guidelines on intradialytic parenteral nutrition in chronic renal disease
  1. M. Ercilla,
  2. A. Celayeta,
  3. C. Ripa,
  4. A. Madueño,
  5. M. Ayerregaray,
  6. P. Carmona,
  7. M. Gayan,
  8. B. Odriozola
  1. 1Donostia University Hospital, Pharmacy, San Sebastián, Spain
  2. 2Donostia University Hospital, Nephrology, San Sebastián, Spain

Abstract

Background The Spanish Nephrology Society and the Spanish Enteral and Parenteral Nutrition Society issued a consensus statement about indications, contraindications and the composition of intradialyticparenteral nutrition (IDPN) in 2010.

View this table:
Table 1

Purpose To find out whether these guidelines are being followed.

Materials and methods Patients who started IDPN during 2010 were included. Medical histories were revised retrospectively. The start and end date, subjective global assessment (SGA), intake of food, body mass index (BMI), age, creatinine, albumin and prealbumin were recorded.

Results 21 patients were included. Median age was 63. Start criteria: all had found supplementary oral intake impossible and had rejected a nasogastric tube according to the consensus. In addition, 3 criteria referred to in the table had to be present.

Composition criteria: All patients had Oliclinomel N7-1000 ml (Baxter). It complied with the recommendations except that:

  • It had 40 grams of protein, which corresponded to 0.5-0.8 g/kg/day (consensus 0.8-1.2/kg/day)

  • It had no vitamins, no added insulin and no phosphorus

  • Carnitine was not added in dyslipidaemic patients

Discontinuation criteria: Only albumin was assayed. No patients were discontinued because of complications or intolerance. Four patients complied with the discontinuation criteria (albumin >3.8 g/dl).

Conclusions 19% of patients fulfilled the start criteria, 43% the discontinuation criteria and the composition did not fully fit the consensus. Initial screening should be improved by recording caloric and protein intake and SGA. It would be desirable to choose an IDPN better adapted to protein needs, and consider the addition of vitamins and carnitine in dyslipidaemic patients, as well as individualising phosphorus and insulin requirements.

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