Intradialytic parenteral nutrition in Australian renal units

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The objective of this study is to document the patterns of usage regarding intradialytic parenteral nutrition (IDPN) within in-center hemodialysis units in Australia” Lambert and Conley (2019).

Abstract:

OBJECTIVE: The objective of this study is to document the patterns of usage regarding intradialytic parenteral nutrition (IDPN) within in-center hemodialysis units in Australia.

DESIGN AND METHODS: This study used purposive non-probabilistic sampling to obtain details of the proportion of units using IDPN; formulations used; infusion rates; and barriers and enablers to usage. All participants were practicing renal dietitians in Australia. The participants were recruited from professional nephrology networks and completed a cross-sectional self-administered online survey.

RESULTS: A total of 68 responses were received, representing 41% of dialysis units in Australia. Half did not use IDPN at all, and one-third (38.2%) used it regularly. The most common IDPN formulations used were triple phase bags (48.3%) and lipid-only infusions (22.6%). Variation in practice was seen regarding maximum infusion rates for some formulations. Costs for IDPN were borne by dialysis units (74%) or pharmacy (16%). Barriers to the use of IDPN included bureaucratic hurdles and misconceptions about IDPN as an effective form of nutrition support. The presence of a protocol, support from medical and other staff, and dietitian experience were enablers to the use IDPN.

CONCLUSIONS: IDPN use in Australia is not uncommon. This survey extends the small evidence base about the practice of IDPN and identified some important variations in practice. Some barriers to IDPN use could be overcome with further training to support staff. Enablers to IDPN use include protocols with defined responsibilities and access to experienced clinicians.

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Reference:

Lambert, K. and Conley, M.M. (2019) Practice Patterns Relating to the Use of Intradialytic Parenteral Nutrition in Australian Renal Units: Results From a Survey of Renal Dietitians. Journal of Renal Nutrition. August 12th. doi: 10.1053/j.jrn.2019.05.003. .

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