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Intradialytic Parenteral Nutrition: Practical Aspects and Management in End-Stage Renal Disease

Protein-Energy Wasting (PEW) is common among patients with End Stage Renal Disease (ESRD) and is associated with a significant increase of the already high morbidity/mortality risk in this population. Since one of the main mechanisms of PEW in ESRD is the insufficient nutrient intake, oral nutritional supplements have been extensively used in this clinical setting, and they have been demonstrated to be very efficient in preventing and treating PEW. Also, other approaches have been proposed as nutritional support modalities, such for example intradialitic parenteral nutrition (IDPN). However, despite the demonstration of nutritional and metabolic status improvement by IDPN, there is still poor evidence relating this modality with reduction in hospitalization rate and mortality risk. On this basis, the present review is aimed at reviewing nutritional support practice in the treatment of PEW in ESRD, with a more in depth focus on the role of IDPN as a modality of nutritional supplementation. To this purpose, indications and quantitative/qualitative aspects of IDPN, as well as IDPN management, safety issues and limitations will be discussed.