RationaleWe completed a 1,118 patient cluster randomised trial of evidence−based guidelines (EBG) for nutrition support in critical illness. The EBG resulted in significant improvements in nutritional support and a reduction in clinically significant renal dysfunction (RD) (1.54 vs 2.12 RD days per 10 patient•days, p=0.038). This exploratory post−hoc analysis investigates renal outcomes in a subgroup of patients at high risk of acute renal failure (ARF). MethodsHigh risk of ARF was defined as creatinine increase by > 20% at study entry, to at least 1.36 mg/dL, compared to last known pre−enrolment levels in the presence of a known risk factor for ARF. P−values were adjusted for clustering. Results are considered hypothesis generating. Results 242 high risk patients were identified (128/561 EBG vs 114/557 control, p=0.60). 63% were males, average age was 64, and APACHE II was 27. There was no baseline imbalance. EBG patients received more nutritional support (8.0 vs 6.5 days per 10 day stay, p=0.009), with a trend towards higher protein (48 vs 37 gm/day, p=0.074) and calorie (1270 vs 980 kcals per day, p=0.083) intake. There was no difference in the proportion of patients experiencing RD (73% vs 82%, p=0.137), but RD was shorter in EBG patients (3.8 vs 5.6 RD days per 10 patient•days, p=0.009). Significantly fewer EBG patients required renal replacement therapy (RRT) (33% vs 46%, p=0.028) however the duration of RRT did not differ (2.0 vs 2.3 RRT days per 10 patient•days, p=0.642). ConclusionsIn animal models, infusions of amino acids can ameliorate the severity of ischemic ARF and enhance renal cell regeneration. Our findings suggest protein intake in critical illness may reduce the severity of renal dysfunction and need for RRT. Future trials with greater power should investigate this relationship. This abstract is funded by: ANZIC Foundation.
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