You will receive IDPN/IPN therapy during each dialysis treatment. Your doctor and dietitian will monitor your progress closely through lab tests and other evaluations. When your protein returns to normal levels, they will determine when to discontinue therapy. You might take a “holiday” from the therapy to see if you can maintain your nutrition levels on your own. Each individual responds differently to therapy, so the length of time therapy is administered will vary from person to person.
Dialysis patients have higher nutritional needs, especially protein. Some dialysis patients may not have a good appetite or find it difficult to tolerate or afford oral nutritional supplements. IDPN/IPN therapies can provide significant amounts of necessary protein without requiring you to drink or eat. Protein is essential for tissue repair and wound healing as well as protecting you against infections. Dialysis patients need approximately 50% more protein than people not receiving treatments.
Intraperitoneal Nutrition (IPN) is a therapy that provides protein as part of your regular dialysis regimen. Your Pentec Health nurse will add protein to your cycler or CAPD bag by removing some of the dextrose. The IPN will also provide the dialysis that is prescribed. Your doctor and dietitian can determine if you could benefit from IPN therapy.
Because Pentec Health’s IPN therapy is individualized and prepared safely based on your patient’s current PD regimen, he or she should not experience any side effects. If dehydration, or any other reported side effect does occur, a Renal Clinical Case Manager or Pharmacist can help determine the cause and treat it accordingly. Sometimes, dehydration can occur if the IPN is providing additional ultrafiltration.
A Renal Clinical Case Manager will ask the PD nurse to fill out the IPN prescription form once a covered benefit has been established for the therapy. The PD nurse will tell the RCCM what type, size and strength of bags the patient is currently using and together they will determine how to fit IPN in the current PD regimen.
Fluid removal should be based on the astute judgment of the RN. However, there is free fluid in the IDPN that can be calculated in the fluid removal goal. For 2-in-1 IDPN, we suggest removing 80% of the total volume. For 3-in-1 IDPN, we suggest removing 75% of the total volume.
The dextrose used is derived from a corn base. If the patient has a true IgE allergy, then dextrose formulations are contraindicated.
Renal Clinical Case Managers review various lab markers. They primarily focus on, but are not limited to, albumin, nPCR, BUN, Kt/v, CO2, potassium, phosphorus and PTH. It is very important that they review treatment time and current weight quarterly as well. Anytime there is a major change with a patient, the RCCM should be notified.
The amount of dextrose varies per patient based on his or her weight, dialysis runtime and whether or not weight gain is the goal. Patients who are not receiving a lipid formula will receive between 2–3gm/kg/min. For those who are receiving a lipid formula, they will receive 4–8mg/kg/min.
Each patient responds differently to the therapy so the response time will vary. Depending on the goal of therapy, whether it is an increase in albumin level, weight or both, we would typically like to see an increase in albumin level and/or weight after three months of therapy without a break in service.
How long a patient needs to receive IDPN/IPN depends on the severity of the malnutrition and why the malnutrition has occurred. A Renal Clinical Case Manager (RCCM) will monitor your patient’s progress closely through lab tests and other evaluations. The patient’s lab results will be reviewed at least quarterly, and more frequently if the clinician alerts the RCCM of a change in nutritional status. Typically, the goal of the IDPN therapy is to see an albumin level increase to 4.0g/dL. Once the albumin level has reached this goal, we will determine when the therapy can be discontinued. The RCCM might suggest to hold the therapy or take a “holiday” from it to see if the patient can maintain nutritional levels on his or her own. Each individual responds differently to the therapy, so the length of time therapy is administered will vary from patient to patient.
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