What are the risks of IDPN?

January 2, 2026 •

6 min read

An estimated 25%–40% of patients undergoing dialysis suffer from protein-energy malnutrition, leading to increased morbidity and mortality. To address this, many may consider intradialytic parenteral nutrition (IDPN), which delivers nutrients during dialysis sessions. However, like any medical intervention, understanding the associated risks of IDPN is crucial for both patients and healthcare providers.

Quick Summary

Intradialytic parenteral nutrition (IDPN) poses risks including metabolic issues like hyperglycemia and hypertriglyceridemia, infection related to the vascular access, and fluid overload. While generally considered safe and effective when standard nutritional therapies fail, patients should be carefully monitored for these complications. Costs and questionable long-term benefits versus other nutritional support options are also a concern.

Key Points

Metabolic Disturbances: IDPN can cause hyperglycemia, hypertriglyceridemia, and dangerous electrolyte shifts, requiring careful monitoring.
Infection Risk: Use of the dialysis vascular access increases the risk of bloodstream infections, emphasizing the need for strict aseptic procedures.
Fluid Overload: The additional fluid volume from IDPN must be managed carefully through adjusted ultrafiltration during dialysis to prevent overload.
Suboptimal Outcomes: Current evidence does not consistently show that IDPN improves mortality, hospitalization rates, or quality of life more effectively than lower-cost oral supplements.
Costly Treatment: IDPN is a significantly more expensive therapy compared to dietary counseling and oral supplements, making it a last-resort option.
Comprehensive Monitoring Required: A robust monitoring plan, including regular checks of blood glucose, electrolytes, and fluid status, is essential to mitigate IDPN-related risks.
Reserved for Failed Therapies: IDPN is generally recommended only after less-invasive nutritional support options, such as oral supplements or enteral feeding, have failed.

Common Risks of IDPN: Understanding the Complications

Intradialytic parenteral nutrition (IDPN) is a supportive therapy for malnourished hemodialysis patients, providing essential nutrients directly into the bloodstream during treatment. Although it can be a critical tool for improving nutritional status, it is not without potential risks that require careful management. The complications can generally be categorized into metabolic disturbances, infection risks, fluid-related issues, and other procedural or systemic side effects.

Metabolic Complications

IDPN can introduce significant amounts of glucose and lipids into the patient's system, potentially disrupting metabolic balance. Patients on dialysis already have complex metabolic profiles, and adding parenteral nutrition requires vigilant monitoring.

Hyperglycemia

IDPN formulations often contain dextrose, posing a risk of high blood sugar (hyperglycemia), especially in diabetic patients or those with stress-related metabolic changes. This risk is elevated with high infusion rates or improper insulin adjustments. Managing blood sugar during and after dialysis is a key safety measure. Conversely, early cessation of IDPN can lead to rebound hypoglycemia.

Hypertriglyceridemia

Lipid emulsions in IDPN can increase serum triglyceride levels. Careful management is needed, particularly for patients with pre-existing elevated lipid levels, as high triglycerides are linked to pancreatitis and cardiovascular issues. Lipid-free or lower-lipid formulas might be considered in some cases.

Electrolyte and Mineral Imbalances

A high dextrose load in IDPN can stimulate insulin release, causing rapid shifts of phosphate and potassium into cells and potentially dangerous hypophosphatemia and hypokalemia. These imbalances are characteristic of refeeding syndrome and can lead to severe complications like cardiac arrhythmias and respiratory failure.

Vascular Access-Related and Infectious Risks

IDPN utilizes the existing dialysis access, which is convenient but introduces risks related to the site and infusion process.

Infection: Using the hemodialysis access for IDPN increases the risk of contamination and bloodstream infections (sepsis). This risk is amplified by any lapses in sterile technique. Given that dialysis patients are often immunocompromised, strict protocols are vital. Localized infections at the catheter site are also a concern.
Catheter Occlusion and Thrombosis: Infusion of nutritional fluids can contribute to blood clots or blockage of the catheter. Regular monitoring and proper catheter care are crucial to prevent these issues.

Fluid Overload and Other Adverse Effects

IDPN infusion adds to a patient's overall fluid volume. For dialysis patients who already have fluid management challenges, this can risk volume overload, requiring careful accounting for the extra fluid during dialysis ultrafiltration. Other potential side effects include:

Gastrointestinal symptoms: Nausea, vomiting, and diarrhea can occur, potentially due to the lipid load or rapid infusion.
Other symptoms: Flushing and muscle pain have also been reported.
Liver issues: While less common than with continuous total parenteral nutrition (TPN), long-term IDPN use can lead to liver dysfunction.

Comparison of IDPN Risks vs. Benefits


Aspect	IDPN Risks	IDPN Potential Benefits
Metabolic	Hyperglycemia, hypertriglyceridemia, hypophosphatemia, hypokalemia	Provides amino acids to counteract protein loss during dialysis
Infection	Increased risk of bloodstream infection from vascular access use	Convenient delivery via existing access, non-invasive
Fluid	Risk of fluid overload requires careful ultrafiltration management	Additional fluid is removed during the dialysis session
Cost	Significantly higher cost compared to oral supplements	Can prevent costly hospitalizations due to malnutrition
Efficacy	Evidence on long-term clinical outcomes like mortality is inconclusive	Improves some nutritional markers (e.g., serum albumin)

The Importance of Patient Monitoring

To minimize IDPN risks, a comprehensive monitoring plan is essential, including regular checks of nutritional markers, vital signs, and patient symptoms.

Key Monitoring Elements for IDPN Patients:

Blood Glucose: Frequent checks are needed, especially for the first few treatments and in diabetic patients.
Electrolyte Levels: Regularly monitor potassium and phosphate to detect early signs of refeeding syndrome.
Lipid Levels: Track triglyceride and cholesterol levels, particularly when starting or adjusting lipid-containing formulas.
Fluid Status: Assess for signs of fluid overload before, during, and after dialysis, adjusting ultrafiltration as needed.
Access Site: Inspect the vascular access for signs of infection.
Subjective Assessment: Ask the patient about any new or concerning symptoms.

Conclusion

What are the risks of IDPN? In summary, IDPN carries risks such as metabolic issues, infection, and fluid overload. While beneficial for severe malnutrition in dialysis patients who haven't responded to other therapies, it requires close medical supervision and rigorous monitoring. A careful, individualized approach that weighs benefits against risks is key to minimizing complications and optimizing outcomes for patients receiving intradialytic parenteral nutrition.

Potential Complications Associated with IDPN

Hyperglycemia: High blood sugar can occur, especially in diabetic patients, and requires careful monitoring during infusion.
Hypertriglyceridemia: The lipid component of IDPN can raise triglyceride levels, necessitating regular blood tests.
Fluid Overload: The extra volume from the infusion must be removed during dialysis to prevent fluid accumulation.
Infection: The use of the dialysis vascular access increases the risk of bloodstream infections.
Catheter Thrombosis: There is a risk of blood clots forming in the dialysis catheter.
Refeeding Syndrome: Can occur in severely malnourished patients and cause dangerous electrolyte shifts, particularly hypophosphatemia.
Gastrointestinal Distress: Nausea, vomiting, and diarrhea are reported side effects.
Liver Issues: Long-term use has been associated with liver function abnormalities, although this is less prevalent than with continuous TPN.
Cost: IDPN is a significantly more expensive treatment option than oral nutritional supplements.

Other Considerations and Patient Care

Monitoring Protocol: Regular blood glucose, electrolyte, and lipid level checks are crucial for patient safety.
Adjunctive Therapy: IDPN is a supplement and does not replace regular oral or enteral nutrition.
Patient Education: Educating the patient on potential side effects and the importance of reporting symptoms is vital for early intervention.

What are the risks of IDPN? FAQs

Question: How common are infections with IDPN? Answer: Infections are a primary risk, as using the existing vascular access for additional infusions increases the chance of bloodstream infections or catheter-site contamination. Proper aseptic technique and vigilant monitoring are crucial for prevention.

Question: Can IDPN cause low blood sugar? Answer: While the primary glucose risk is hyperglycemia, abruptly stopping IDPN before the end of the dialysis session, especially with excessive insulin administration, can cause a hypoglycemic rebound effect.

Question: What is refeeding syndrome, and how is it related to IDPN? Answer: Refeeding syndrome is a dangerous metabolic complication that can affect severely malnourished patients when nutritional support is initiated. It is characterized by rapid electrolyte shifts (hypophosphatemia, hypokalemia) and fluid imbalances, which IDPN can trigger, especially with a high dextrose load.

Question: Does IDPN cause weight gain? Answer: The goal of IDPN is to improve nutritional status and aid in healthy weight gain, particularly by restoring lean tissue mass. However, the weight gain should be monitored to ensure it isn't simply fluid retention from volume overload.

Question: How is fluid overload managed with IDPN? Answer: The extra fluid from the IDPN infusion is incorporated into the total fluid removal calculation for the dialysis session. The ultrafiltration targets are adjusted to remove the additional volume while also accounting for any fluid gains between sessions.

Question: Is IDPN always better than oral nutritional supplements? Answer: No, IDPN is typically reserved for patients who have not responded adequately to other nutritional support methods, such as dietary counseling and oral supplements. Evidence on long-term outcomes like mortality and hospitalization rates does not definitively prove IDPN is superior to oral supplementation.

Question: Are there any alternatives to IDPN? Answer: Alternatives include dietary counseling, oral nutritional supplements (ONS), and enteral tube feeding for patients with a functional gastrointestinal tract. Total parenteral nutrition (TPN) is another option for those who cannot tolerate any oral or enteral intake.

Question: Is IDPN used for pediatric patients? Answer: Yes, IDPN can be used for malnourished pediatric hemodialysis patients, especially when standard interventions fail. However, evidence on long-term benefits in children is limited, and specific protocols are required.

Question: What should a patient do if they experience side effects during IDPN? Answer: Patients should immediately report any concerning symptoms, such as nausea, vomiting, unusual pain, or flushing, to their dialysis clinic staff. The infusion rate or formula may need to be adjusted to improve tolerance.

Question: Does IDPN affect liver function? Answer: Although prolonged or total parenteral nutrition (TPN) has a known risk of liver dysfunction, the intermittent and supplemental nature of IDPN makes severe liver issues less common. However, liver function should be monitored as part of the overall patient care.

Question: Can IDPN be used alongside other medications? Answer: Healthcare providers must verify compatibility before co-administering any medications with IDPN. Some medications, like certain antibiotics, may be discouraged from being infused simultaneously.

Frequently Asked Questions

The primary infection risk is a bloodstream infection or sepsis, which can occur due to contamination at the vascular access site used for the infusion. The risk is managed by following strict sterile procedures during administration.

The dextrose, or carbohydrate, component of the IDPN formula can cause hyperglycemia, especially in patients with diabetes or stress-related metabolic issues. Glucose levels must be closely monitored during infusion.

Yes, indirectly. IDPN can trigger refeeding syndrome in severely malnourished patients, leading to severe hypophosphatemia and hypokalemia (low phosphate and potassium). These electrolyte imbalances can cause dangerous heart rhythm abnormalities.

IDPN is considered a last-resort option because it is significantly more expensive than other nutritional interventions like oral supplements, and evidence on its long-term benefits for clinically important outcomes is limited and inconclusive.

If a patient receives too much fluid with IDPN, it can lead to fluid overload. To prevent this, the extra volume is calculated and removed during the ultrafiltration process of the dialysis session.

Initially, blood glucose levels are often checked more frequently (e.g., pre-, mid-, and post-dialysis). Subsequently, electrolytes, lipids, and nutritional markers are typically monitored on a regular schedule, such as every 4–6 weeks, alongside regular dialysis blood work.

IDPN is most effective for malnutrition with an organic cause. It may be less effective for psychological or psychosocial reasons for poor intake, which often require other interventions in addition to nutritional support.