Challenges of providing nutrition support in the outpatient dialysis setting.

@article{citeulike:2932451, abstract = {Malnutrition is prevalent in maintenance hemodialysis (MHD) patients and has been strongly associated with increased morbidity and mortality. There are numerous contributors to the development, occurrence, and persistence of malnutrition in the MHD patient. Intensive diet counseling and use of enteral supplements may not be effective interventions for patients exhibiting high nutrition risk. More aggressive nutrition options such as enteral and parenteral support are less often used and have associated risks. Intradialytic parenteral nutrition (IDPN) as a form of PN delivered during the dialysis procedure is a convenient and attractive convention that is underused because of its history and controversy. There is a lack of randomized controlled trials demonstrating improved morbidity and mortality with all nutrition support interventions in MHD patients. This research is particularly crucial for IDPN in order to render change in Medicare reimbursement. Qualification of patients for this therapy is difficult because of the very strict coverage criteria. For those patients who do qualify for IDPN, clinician nutrition support knowledge is essential for safe administration of solutions and effective physical, metabolic, and nutrition management of the patient. Attention to other factors that contribute to malnutrition in MHD such as treatment adequacy and comorbid conditions is important; however, the early detection of malnutrition in the MHD patient with appropriate level of nutrition intervention is critical. Future improved understanding of the malnutrition of uremia will allow for development and investigation of other strategies that are anti-catabolic or anabolic.}, address = {Parma DaVita Dialysis, 6735 Ames Drive, Parma, OH 44129, USA. emmoore@davita.com}, author = {Moore, E. and Celano, J. }, citeulike-article-id = {2932451}, issn = {0884-5336}, journal = {Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition}, keywords = {hd, nutrition, treatment}, month = {April}, number = {2}, pages = {202--212}, posted-at = {2008-06-27 04:57:01}, priority = {2}, title = {Challenges of providing nutrition support in the outpatient dialysis setting.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/16207657}, volume = {20}, year = {2005} }

TY - JOUR ID - citeulike:2932451 L3 - citeulike-article-id:2932451 TI - Challenges of providing nutrition support in the outpatient dialysis setting. JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition VL - 20 IS - 2 SP - 202 EP - 212 AD - Parma DaVita Dialysis, 6735 Ames Drive, Parma, OH 44129, USA. emmoore@davita.com SN - 0884-5336 N2 - Malnutrition is prevalent in maintenance hemodialysis (MHD) patients and has been strongly associated with increased morbidity and mortality. There are numerous contributors to the development, occurrence, and persistence of malnutrition in the MHD patient. Intensive diet counseling and use of enteral supplements may not be effective interventions for patients exhibiting high nutrition risk. More aggressive nutrition options such as enteral and parenteral support are less often used and have associated risks. Intradialytic parenteral nutrition (IDPN) as a form of PN delivered during the dialysis procedure is a convenient and attractive convention that is underused because of its history and controversy. There is a lack of randomized controlled trials demonstrating improved morbidity and mortality with all nutrition support interventions in MHD patients. This research is particularly crucial for IDPN in order to render change in Medicare reimbursement. Qualification of patients for this therapy is difficult because of the very strict coverage criteria. For those patients who do qualify for IDPN, clinician nutrition support knowledge is essential for safe administration of solutions and effective physical, metabolic, and nutrition management of the patient. Attention to other factors that contribute to malnutrition in MHD such as treatment adequacy and comorbid conditions is important; however, the early detection of malnutrition in the MHD patient with appropriate level of nutrition intervention is critical. Future improved understanding of the malnutrition of uremia will allow for development and investigation of other strategies that are anti-catabolic or anabolic. KW - hd KW - nutrition KW - treatment AU - Moore, E AU - Celano, J PY - 2005/04// UR - http://view.ncbi.nlm.nih.gov/pubmed/16207657 ER -