- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05568914
Intra Dialytic Parenteral Nutrition and Nutritional Gap Nutritional Gap Identified by Indirect Calorimetry (DiaPaNIC)
December 5, 2023 updated by: Universitair Ziekenhuis Brussel
Intra Dialytic Parenteral Nutrition During Intermittent Hemodialysis Can Close the Nutritional Gap Identified by Indirect Calorimetry: a Pilot and Feasibility Study
Renal failure is a relevant condition as the incidence of patients treated with intermittent dialysis continues to grow each year.
One of the strongest predictors of mortality in these patients is Protein-Energy Wasting (PEW).
Optimal nutritional support, combined with physical exercise may be able to improve the physical condition objectified as muscle wasting and weakness.
Correct nutritional support must aim to supplement the correct combination of protein and caloric needs.
Although no other way exist than predicting formula to assess protein need, predicting formula don't seem to capture the individual caloric need of the patients.
The gold standard to assess caloric need by measuring Resting Energy Expenditure (REE) is indirect calorimetry.
Even when caloric and protein targets are defined, intake remains a challenge because of intake restriction in dietary patterns.
This is why intradialytic parenteral nutrition (IDPN) can play an crucial role for closing the nutritional gap.
Whether IDPN guided by indirect calorimetric measurements of metabolism can close the gap when oral intake fails, remains an unanswered question.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Renal failure is a relevant condition as the incidence of patients treated with renal replacement therapy and specifically intermittent dialysis, continues to grow each year.
In 2021 up to 4845 patients required intermittent dialysis in Flanders, Belgium.
Weight loss and homeostatic disturbances of energy and protein balances are often present in Chronic Kidney disease (CKD) and end-stage renal disease (ESRD).The international society of renal nutrition and metabolism defines Protein-Energy Wasting (PEW) as the state of nutritional and metabolic disorders in patients with CKD and ESRD, characterized by simultaneous loss of systemic body protein and energy stores.
PEW is one of the strongest predictors of mortality in CKD patients.
Up tot 54% of adults undergoing chronic intermittent haemodialysis (IHD) suffer from PEW due to a combination of the disease and therapy.
Adequate nutritional therapy can reverse the negative impact of PEW.
Optimal nutritional support, next to physical exercise may be able to improve the physical condition objectified as muscle wasting and weakness.
Correct nutritional support must aim to supplement the correct combination of protein and caloric after assessing the needs and intake of different nutrients.
Although no other way exist than predicting formula to assess protein need, predicting formula don't seem to capture the individual caloric need of the patients.
The gold standard to assess caloric need by measuring Resting Energy Expenditure (REE) is indirect calorimetry.
This technique measures the individual VCO2 and VO2 and after integrating it into the Weir equation it calculates REE.
Even when caloric and protein target are defined, intake remains a challenge because of intake restriction in dietary patterns.
This is why intradialytic parenteral nutrition (IDPN) can play an crucial role for closing the nutritional gap.
In clinical practice, in 38% of dialysis patients, IDPN is used.
The most common IDPN were triple phase bags.
Whether IDPN guided by indirect calorimetric measurements of metabolism can close the gap when oral intake fails, remains an unanswered question.
Study Type
Interventional
Enrollment (Estimated)
20
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Elisabeth De Waele, MD, PhD
- Phone Number: +3224763354
- Email: elisabeth.dewaele@uzbrussel.be
Study Locations
-
-
Brussel
-
Jette, Brussel, Belgium, 1090
- Recruiting
- Universitair Ziekenhuis Brussel
-
Contact:
- Elisabeth De Waele, MD. PhD.
- Phone Number: +3224763344
- Email: elisabeth.dewaele@uzbrussel.be
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Patient on intermittent hemodialysis
- Protein-Energy Wasting defined as 5% within 3 months or 10% within 6 months (not due to water loss, established at the discretion of the treating physician)
Exclusion Criteria:
- Pregnancy
- Contra-indications for the use of indirect calorimetry as stated by the AARC (oxygen therapy for COPD,...)
- Metabolic diseases
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Assessments
In this single-arm trial, each participant undergoes the following measurements/assessments: Physical: Body weight (before and after dialysis), length Biophysical: NRS2002, GLIM, Bio-electrical Impedance Analysis Metabolic: Indirect Calorimetry Nutritional: dietary anamnesis, 3-days nutritional diary |
Indirect Calorimetry (Q-NRG Metabolic Monitor, COSMED) is performed to determine the Resting Energy Expenditure before hemodialysis.
Other Names:
Bio-electrical Impedance Analysis (BIA101/BIVA, Akern) is used to analyse the body composition (Fat Mass, Fat Free Mass, Phase Angle).
Other Names:
The Nutritional assessments consist of a dietary anamnesis and a 3-day nutritional diary to determine the nutritional (caloric and protein) intake of the participants.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Caloric adequacy
Time Frame: Pre-dialysis
|
caloric intake (kcal/day) and caloric need (kcal/day) (see secondary outcomes) will be combined to report caloric adequacy according to this equation: [sum of percentage of caloric intake/caloric need]/total of evaluable nutrition days (%)
|
Pre-dialysis
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Protein adequacy
Time Frame: Pre-dialysis
|
protein intake (from nutritional assessments)/protein need (%)
|
Pre-dialysis
|
Fat Mass (FM)
Time Frame: 20-30 minutes after dialysis
|
measured by Bio-electrical Impedance Analysis (BIA) (kg and %);
|
20-30 minutes after dialysis
|
Fat Free Mass (FFM)
Time Frame: 20-30 minutes after dialysis
|
measured by Bio-electrical Impedance Analysis (BIA) (kg and %);
|
20-30 minutes after dialysis
|
Phase angle
Time Frame: 20-30 minutes after dialysis
|
measured by Bio-electrical Impedance Analysis (BIA) (kg and %);
|
20-30 minutes after dialysis
|
Body weight
Time Frame: before and after hemodialysis
|
Body weight (kg)
|
before and after hemodialysis
|
Mean caloric intake
Time Frame: pre-dialysis
|
(kcal/day) from nutritional assessments (3-day nutritional diary and nutritional anamnesis
|
pre-dialysis
|
Caloric need
Time Frame: pre-dialysis
|
(kcal/day): Resting Energy Expenditure (REE) measured by Indirect Calorimetry (IC)
|
pre-dialysis
|
Mean protein intake
Time Frame: pre-dialysis
|
g/day): from nutritional assessments (3-day nutritional diary and nutritional anamnesis
|
pre-dialysis
|
Barriers for patients for use of IDPN
Time Frame: pre-dialysis
|
"would you agree to IDPN if your health condition required it?
Please elaborate"
|
pre-dialysis
|
Barriers for dialysis nurses and nephrologists for use of IDPN
Time Frame: throughout the duration of the trial
|
"Are logistical and practical barriers holding you back from prescribing or administering IDPV?
Please elaborate."
|
throughout the duration of the trial
|
Compatibility between the caloric gap and PN ready to use formulae on the market
Time Frame: through study completion or one year, whichever is sooner
|
Comparison between individual caloric need of patients and ready to use PN formulae (PeriOlimel N4E (Baxter), Olimel N5E (Baxter), Olimel N7E (Baxter), Olimel N9/N9E (Baxter), Olimel N12/N12E (Baxter), SMOFKabiven Ex-tra Amino (Fresenius), SMOFKabiven peripheral (Fresenius), SMOFKabiven Peri Low Osmo (Fresenius), SMOFKabiven E/EF (Frese-nius), Omegomel Peri (Baxter), Nutriflex Omega Special (B Braun); based on caloric content per bag of PN on the market (Unit of measurement: portion of PN bag (%) needed to close the caloric gap)
|
through study completion or one year, whichever is sooner
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Descriptive outcomes
Time Frame: pre-dialysis
|
age, sex, category of kidney disease, comorbidities, dialysis vintage (years)
|
pre-dialysis
|
Dialysis type
Time Frame: During dialysis
|
(from medical file)
|
During dialysis
|
Delta REE between predicting formula and indirect calorimetry
Time Frame: Pre-dialysis
|
Difference in energy need as calculated using standard formula and measured using IC
|
Pre-dialysis
|
Vascular access type
Time Frame: during dialysis
|
(from medical file)
|
during dialysis
|
Dialysis blood flow rate
Time Frame: During dialysis
|
(from medical file)
|
During dialysis
|
Hemodialysis treatment adequacy (kt/V)
Time Frame: During dialysis
|
(from medical file)
|
During dialysis
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Elisabeth De Waele, MD, PhD, Universitair Ziekenhuis Brussel
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 4, 2023
Primary Completion (Estimated)
August 31, 2024
Study Completion (Estimated)
August 31, 2024
Study Registration Dates
First Submitted
August 30, 2022
First Submitted That Met QC Criteria
September 30, 2022
First Posted (Actual)
October 6, 2022
Study Record Updates
Last Update Posted (Estimated)
December 6, 2023
Last Update Submitted That Met QC Criteria
December 5, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2022-EDW-DiaPaNIC
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Chronic Kidney Diseases
-
3-C Institute for Social DevelopmentUniversity of North Carolina, Chapel HillCompletedChronic Kidney Diseases | Chronic Kidney Disease Stage 5 | Chronic Kidney Disease stage4 | Pediatric Kidney Disease | Chronic Kidney Disease stage3 | Chronic Kidney Disease Stage V | Chronic Kidney Disease, Stage IV (Severe) | Chronic Kidney Disease Stage 2 | Chronic Kidney Disease, Stage IUnited States
-
American Academy of Family PhysiciansUniversity of Colorado, Denver; National Institute of Diabetes and Digestive... and other collaboratorsCompletedChronic Kidney Disease | Chronic Renal Insufficiency | Chronic Kidney Insufficiency | Chronic Renal Diseases | Kidney Insufficiency, ChronicUnited States
-
Universiti Putra MalaysiaRecruitingChronic Kidney Diseases | Chronic Kidney Disease Stage 5 | Chronic Kidney Disease stage4 | Chronic Kidney Disease stage3 | Chronic Kidney Disease Requiring Chronic DialysisMalaysia
-
Centre Hospitalier le MansLe Mans UniversiteWithdrawnFatigue | Chronic Kidney Disease Stage 5 | Chronic Kidney Disease stage3 | Chronic Kidney Failure | Chronic Kidney Disease, Stage 4 (Severe)
-
National Taiwan University HospitalCompletedChronic Kidney Disease stage4 | Chronic Kidney Disease stage3 | Chronic Kidney Disease Stage 2 | Chronic Kidney Disease Stage 1Taiwan
-
Centre Hospitalier le MansLe Mans UniversiteRecruitingFatigue | Chronic Kidney Disease Stage 5 | Chronic Kidney Disease stage4 | Chronic Kidney Disease Stage 3BFrance
-
University of WashingtonJohns Hopkins University; National Institute of Diabetes and Digestive and... and other collaboratorsRecruitingChronic Kidney Diseases | Acute Renal Failure | Acute Renal Injury | Acute Kidney Failure | Chronic Renal Insufficiency | Kidney Failure, Acute | Renal Insufficiency, Acute | Acute Renal Insufficiency | Acute Kidney Insufficiency | Renal Failure, Acute | Chronic Kidney Insufficiency | Chronic Renal Diseases | Kidney... and other conditionsUnited States
-
University of the State of Santa CatarinaUnknownKidney Diseases | Chronic Kidney Diseases | Hemodialysis | Chronic Renal Insufficiency | Renal Dialysis | Chronic Kidney Insufficiency | Chronic Renal DiseasesBrazil
-
Texas A&M UniversityWithdrawnChronic Kidney FailureUnited States
-
Lund UniversityBaxter Healthcare Corporation; Universidad de CórdobaCompletedEnd Stage Kidney Disease | Chronic Kidney Disease Requiring Chronic DialysisArgentina
Clinical Trials on Indirect Calorimetry
-
University of HohenheimCompleted
-
Australian and New Zealand Intensive Care Research...RecruitingObesity | Critical IllnessAustralia
-
Karolinska University HospitalKarolinska InstitutetRecruitingCritical IllnessAustralia, Switzerland, Sweden, Netherlands
-
University of LiegeRecruitingBurns | Critical Illness | Nutrition Disorders | Resting Energy Expenditure | Indirect CalorimetryBelgium
-
University Hospital, Clermont-FerrandLaboratoire des Adaptations Métaboliques à l'Exercice en conditions Physiologiques... and other collaboratorsRecruitingDiabetes | Anorexia Nervosa | Cancer Survivor | Juvenile Idiopathic Arthritis | Inflammatory Bowel DiseaseFrance
-
Centre Hospitalier ArrasCompletedCOVID-19 | ObesityFrance
-
University Hospital, GenevaSuspendedResting Energy Expenditure | Long-term Non-invasive Ventilation | Obesity-hypoventilation SyndromeSwitzerland
-
Federal University of Minas GeraisCompletedBone Marrow Transplantation | Hematopoietic Stem Cell TransplantationBrazil
-
Great Ormond Street Hospital for Children NHS Foundation...TerminatedCritical Illness | Child | Fever
-
Ospedale San DonatoCompleted