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|Issue 142||April 2018|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Brief: Treatment for Malnutrition in Hemodialysis Patients
Chronic kidney disease (CKD) is a major public health concern, affecting 15% of US adults in 2011-2014, and was the 9th leading cause of death in the U.S. in 2016. Progression of CKD leads to end-stage renal disease – permanent failure of kidney function requiring kidney transplant or maintenance hemodialysis. Malnutrition affects 20-60% of hemodialysis patients and is one of the strongest predictors of mortality and morbidity in this population. Guidelines recommend nutritional counseling and oral nutrition supplements as first-line treatment; if these strategies do not work, enteral tube feeding is recommended. Another treatment strategy is intradialytic parenteral nutrition (IDPN) – a form of partial parenteral nutrition administered during regularly scheduled dialysis sessions. Despite existing guidelines recommending IDPN only for hemodialysis patients with refractory malnutrition, IDPN is commonly being requested or used prior to other treatment options. However, current evidence is inadequate to demonstrate a benefit for IDPN over recommended treatments.
The VA Renal Field Advisory Committee requested an evidence brief on the use of IDPN for the treatment of malnutrition among VA patients receiving hemodialysis. Investigators with VA's Evidence-based Synthesis Coordinating Center in Portland, OR reviewed the literature including MEDLINE®, CINAHL, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, as well as scientific information requests to four manufacturers, from 2009 to October 11, 2017. After reviewing 258 articles, 14 (5 randomized controlled trials, 6 cohort studies, and 3 systematic reviews) were used to answer the following questions:
What is the effectiveness of IDPN for the treatment of malnutrition in hemodialysis patients?
What are the potential adverse effects of using IDPN?
What is the cost-effectiveness of using IDPN?
Do the effectiveness and potential adverse effects of IDPN differ per patient characteristics (i.e., patient demographics, comorbidities, disease severity)?
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.
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