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A Double-Blind Randomized Trial Comparing Outpatient Parenteral Nutrition With Intravenous Hydration: Effect on Resumption of Oral Intake After Marrow Transplantation
Paula M. Charuhas, MS, RD, FADA, CNSD
Department of Clinical Nutrition, Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
Karin L. Fosberg, RD
Department of Clinical Nutrition, Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
Barbara Bruemmer, PHD, RD
Department of Clinical Nutrition, Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
Saundra N. Aker, RD
Department of Clinical Nutrition, Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, Biobehavioral Nursing and Health Systems, Clinical Affiliate, Nutritional Sciences, University of Washington, Seattle
Wendy Leisenring, SCD
Program in Biostatistics, Division of Public Health Sciences and Program in Clinical Statistics, Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
Kristy Seidel, MS
Program in Biostatistics, Division of Public Health Sciences and Program in Clinical Statistics, Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
Keith M. Sullivan, MD
Department of Medical Oncology, Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
Background: Outpatient parenteral nutrition (PN) is often given to marrow transplant recipients after high-dose chemoradiotherapy until the resumption of adequate oral intake; however, it may adversely prolong resumption of oral calorie intake by contributing to early satiety. Methods: A double-blind, randomized study compared standard PN (final concentration 25% dextrose, 5% amino acids) with a hydration solution (5% dextrose) during the first 28 days of outpatient treatment. Patients were eligible for the study if they were  2 years of age, <65 days posttransplant, had <70% oral caloric intake at hospital discharge, and required  10 U insulin/L PN. Solutions were provided until the patient's oral intake met 85% caloric requirements for 3 consecutive days. Results: Two hundred fifty-eight marrow transplant recipients (128, PN and 130, hydration solution) were studied. Age, donor type, and diagnoses were similar in the two groups. Time to resumption of 85% oral caloric intake was 6 days sooner in the hydration group than in the PN group (median 10 vs 16 days, respectively; p = .049). When adjusting for sex, age, donor type, total body irradiation, previous oral intake, acute graft-versus-host disease, and prednisone therapy, the hydration group resumed oral intake sooner than the PN group (relative risk = 1.51; 95% confidence interval [CI] 1.04 to 2.19; P = .029). The percentage of weight change from pretransplant values, adjusted for the above covariates and the number of weeks of treatment, indicated that the hydration solution group lost weight (4.63%) compared with the PN group (1.27%) after 4 weeks of therapy (p = .004). Rates of hospital readmissions, relapse of malignancy, and survival did not differ between the two treatment groups. Conclusions: We conclude that outpatient PN delays resumption of oral intake and that its replacement with hydration solution does not result in adverse patient outcome. (Journal of Parenteral and Enteral Nutrition 21:157-161, 1997)
Journal of Parenteral and Enteral Nutrition, Vol. 21, No. 3,
157-161 (1997)
DOI: 10.1177/0148607197021003157
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