P485 - INFLUENCES ON HOME PARENTERAL NUTRITION ADMIXTURE PRESCRIBING IN ADULTS WITH CHRONIC INTESTINAL FAILURE: A JUDGEMENT ANALYSIS

P485

INFLUENCES ON HOME PARENTERAL NUTRITION ADMIXTURE PRESCRIBING IN ADULTS WITH CHRONIC INTESTINAL FAILURE: A JUDGEMENT ANALYSIS

M. Baker^1,*, M. Hann², S. Lal³, S. Burden¹

¹Health Sciences, ²Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, ³Intestinal Failure and Gastroenterology, Salford Royal, Salford, United Kingdom

 

Rationale: Home Parenteral Nutrition (HPN) admixture choice varies internationally¹. In England, multichamber bags are promoted²

Methods: This study evaluated how nutrient profile influences bespoke HPN use and explored variation in admixture choice.  Healthcare Professionals (HCP) were asked to view the same 32 hypothetical cases and provide a HPN regimen.  Clinical and nutrition details varied in each case

Results: Twenty HCP (65% Dietitians) judged 628 cases. Bespoke HPN bags chosen in 448(71.3%),varying from 50.0-87.5% per judge.  All nutrients assessed were significantly associated with bespoke HPN usage, most important being use of non-lipid bags, in 436(70.0%)cases

 

Table 1:Nutrient Factors Influencing Bespoke HPN Use (multilevel mixed-effect logistic regression model)

Variable	Category	Model coefficient (95% CI)	p	Standardised coef
Volume	Standard   Low High	Ref   -0.49(-1.06,0.08) 0.83(0.20,1.46	0.09 0.01	-0.09 0.14
Lipid	All bags Other	2.83(2.00, 3.67)	<0.001	0.51
Potassium	Standard   Low High	2.25(1.47, 3.03) 1.41(0.93, 1.88)	<0.001  <0.001	0.38 0.23
Phosphate	Standard   Low	2.15(1.44, 2.86)	<0.001	0.39
Calcium	Standard   Low	1.69(0.99, 2.39)	<0.001	0.28

 

Mean(SD) lipid dose was 0.69(0.35)g/kg/day (range 0-1.58g/kg/d). Substantial variation occurred between judges (Intraclass correlation coefficient 0.19(0.06,0.31) p<0.001) with mean dosing in benign HPN indications varying from 0.29-1.01g/kg/day per judge

Conclusion: Decisions about HPN admixture choice and lipid dosing vary among HCP, resulting in prescribing disparity.  Preference for non-lipid bags is common and appears to be the main driver for bespoke HPN use, with non-standard electrolyte dosing also important. Research is required to define optimal lipid dosing and support increased standardisation in HPN prescribing

References: ¹Klek et al (2024) Nutr 123 doi.org/10.1016/j.nut.2024.112396

²Harrison et al (2023) www.bapen.org.uk/bifa

Disclosure of Interest: M. Baker Grant / Research Support from: 23,000Euros British Dietetic Association, M. Hann: None declared, S. Lal: None declared, S. Burden: None declared