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Subject Area

Anesthesiology and Intensive Care

Article Type

Review

Abstract

Objective To summarize the methods of nutritional improvement used in cases of protein-energy wasting in patients on maintenance hemodialysis. Data analysis Search papers, systematic reviews, and randomized clinical trials from 2004 to 2021 were reviewed in the available MEDLINE databases, which included PubMed, Medscape, Springer, Elsevier, and Science Direct. Study selection English language publications that focused on critically ill populations on renal replacement therapy requiring nutritional support were searched. Data extraction: studies by Cano and colleagues, Liu and colleagues, Oğuz and colleagues, Marsen and colleagues, Chioléro and Berger, Fiaccadori and colleagues, Ramakrishnan and Shankar, Al-Dorzi and Arabi, Bost and colleagues, Anderson and colleagues, and Fiaccadori and colleagues were gathered by two authors, which were then reviewed by another author. They extracted data related to the year, total population, method and duration of nutritional supplementation, inclusion criteria, exclusion criteria, and main results for each study. They also collected data on age, sex, length of nutritional aid by month, mean and SD of BMI, weight gain, prealbumin, nutritional status, and any adverse effects. Data synthesis: a structured systematic review was performed. Findings Intradialytic parenteral nutrition enhanced patients' health and clinically relevant nutritional outcomes as compared with oral (enteral) supplementation, with a substantial reduction in mortality. It can enhance some nutritional markers while having well-tolerated adverse effects, making intradialytic parenteral nutrition a feasible therapy option, particularly in circumstances when enteral nutrition cannot be delivered. Conclusion Complete dosage of enteral protein is probably more suitable in the late stages of critical illness, when enteral nutrition is insufficient in the first week. In general, enteral nutrition is favored over parenteral nutrition, should be begun early (within 24–48 h), and should be progressively raised to target over at least a few days.

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