The patient began dialysis on 5/2/17, more specifically this patient started Continuous Cycling Peritoneal Dialysis (CCPD). Patient presented with hypoalbuminemia, with a three month average albumin of 2.4 at time of referral. At that time, the patient was also currently consuming Liquacel 3 times a week to provide 16gms of protein per each serving. The baseline albumin was 2.0 g/ dL. IPN therapy was initiated on 3/27/18 secondary to hypoalbuminenia. Patient is replacing one 6L Baxter dianeal bag with a 6L Baxter IPN bag from Pentec which is providing 90gms of Amino Acids each evening. Due to the increase in the albumin the patient was able to have back surgery in order to repair herniated disks that was causing the patient severe pain which, affected appetite. Patient is still actively receiving IPN and we are awaiting new lab results following the scheduled back surgery.

The patient began dialysis treatment 10/11/10. The patient was referred for IDPN therapy because the 3 month average albumin was less than 3.5g/dL and the current albumin was 2.9g/dl. The patient's weight at the time of referral for IDPN was 55.5kg with a BMI of 18.12 and 84% of the ideal body weight. The patient started IDPN with 78gms of amino acids and maintained the same prescription for 9 months while receiving IDPN. During the 9 months that the patient was on IDPN, weight and albumin steadily increased. The IDPN was stopped in October and the patient was able to maintain the albumin level for several months until the point of surgery to remove the transplanted kidney. After the surgery, the albumin declined slightly, however the decision was made to hold off on restarting therapy.

The patient began dialysis treatment 8/8/14. The patient originally was referred for IDPN therapy due to a 3 month average albumin of 3.1g/dL with a current albumin of 2.9g/dL. Current weight was 60kg with a BMI of 19.5 and the patient was 82.1% of ideal body weight. The patient also had lost 6% of body weight over the last 2 months, further complicating the protein-calorie malnutrition. The patient started IDPN on a lipid formula due to low body weight and recent weight loss to provide extra calories. During the 6 months that the patient was on IDPN, weight and albumin steadily increased. The physician requested to stop IDPN once the weight and albumin had improved and the patient had ultimately met nutritional goals.

She began continuous cycling peritoneal dialysis (CCPD) 4/25/2011. Her past medical history includes congestive heart failure, liver failure with failed liver transplant, hypothyroidism, depression, anxiety, insomnia, coronary artery disease, secondary hyperparathyroidism, anemia, and hypertension. RD referred patient for IPN in April 2016. Patient presented with chronic hypoalbuminemia with a three month average albumin of 2.53. Her baseline albumin was 2.4 in March 2016 and starting target weight of 56.8 kg (BMI 20.21). She was taking the oral supplement Liquacel (1 oz) 3 times per week at home. IPN therapy was initiated on 6/30/16 secondary to meeting the criteria of hypoalbuminemia. During her time on IPN, she has maintained her EDW, experienced an upward trend in nPNA-PD from 1.9 to 2.32, and maintained adequate Kt/V. Overall, the goal of improving protein status and promoting weight maintenance has been achieved.

She began dialysis on 9/19/14. Past medical history includes diabetes, congestive heart failure, gastroparesis, anemia. She presented with hypoalbuminemia, with a three month average albumin of 3.4. At this time, she was also currently consuming Zone protein bar 3 times a week at dialysis to provide 14gms of protein. Her baseline albumin was 3.4g/dL and her starting target weight was 78kg. IDPN therapy was initiated on 12/23/16 secondary to meeting the criteria of protein energy wasting. She was listed on the kidney transplant list and was hoping to increase her albumin level in preparation for surgery. Overall, the goal of improving protein status was achieved. The albumin has increased to 3.7g/dL and she received a Kidney transplant.

He began dialysis on 10/17/14. Past medical history includes hypertension, type 2 diabetes, asthma, anemia and hypertension. He presented with hypoalbuminemia, with a three month average albumin of 3.0, and a recent weight loss of 6% in the last 3 months. At this time, he was also currently consuming Novasource renal 3 times a week at dialysis to provide 21gms of protein. His baseline albumin was 3.0g/dL and his starting target weight was 60.5kg. IDPN therapy was initiated on 2/10/17 secondary to meeting the criteria of protein energy wasting. During his time on IDPN, he did not experience any further substantial weight loss, Kt/V trended above adequate and hemoglobin trended upward throughout the course of time on therapy. Overall, the goal of improving protein status and prevent further weight loss was achieved. The patient was able to maintain a Albumin level of 4.0g/dL for 3 months and no longer needed the IDPN therapy. Below are a few reports made by the RD at a large dialysis chain.

Patient reports “that he is really enjoying having extra energy to do things now"

Per RD "His Albumin has been greater than 4 for the last two months. I have been reluctant to discontinue just because it gives him such a big boost in his mental health as it has to his physical health." RD prefers to monitor and identify if patient is able to maintain status.

Patient X is doing very well. His albumin is 4.1 he is rocking on. Thanks for helping him to get here and feel wonderful."

"He is doing great….he is holding on to his 4.0 albumin level….He is rocking on and feeling amazing."