Critically ill patients with acute kidney injury (AKI) who receive renal replacement therapy (RRT) have very high mortality rate. During RRT, there are markedly loss of macro- and micronutrients which may cause malnutrition and result in impaired renal recovery and patient survival. We aimed to examine the predictive role of macro- and micronutrients on survival and renal outcomes in critically ill patients undergoing continuous RRT (CRRT). This prospective observational study enrolled critically ill patients requiring CRRT at Intensive Care Unit of King Chulalongkorn Memorial Hospital from November 2012 until November 2013. The serum, urine, and effluent fluid were serially collected on the first three days to calculate protein metabolism including dietary protein intake (DPI), nitrogen balance, and normalized protein catabolic rate (nPCR). Serum zinc, selenium, and copper were measured for micronutrients analysis on the first three days of CRRT. Survivor was defined as being alive on day 28 after initiation of CRRT.Dialysis status on day 28 was also determined. Of the 70 critically ill patients requiring CRRT, 27 patients (37.5%) survived on day 28. The DPI and serum albumin of survivors were significantly higher than non-survivors (0.8± 0.2 vs 0.5 ±0.3g/kg/day, p = 0.001, and 3.2±0.5 vs 2.9±0.5 g/dL, p = 0.03, respectively) while other markers were comparable. The DPI alone predicted patient survival with area under the curve (AUC) of 0.69. A combined clinical model predicted survival with AUC of 0.78. When adjusted for differences in albumin level, clinical severity score (APACHEII and SOFA score), and serum creatinine at initiation of CRRT, DPI still independently predicted survival (odds ratio 4.62, p = 0.009). The serum levels of micronutrients in both groups were comparable and unaltered following CRRT. Regarding renal outcome, patients in the dialysis independent group had higher serum albumin levels than the dialysis dependent group, p = 0.01. In conclusion, in critically ill patients requiring CRRT, DPI is a good predictor of patient survival while serum albumin is a good prognosticator of renal outcome.

Background: The Scored Patient-Generated Subjective Global Assessment (PG-SGA) is a multidimensional tool to assess malnutrition and risk factors. The objectives of this study are to determine the validity of the Thai version of the Scored PG-SGA (Thai PG-SGA) and examine the correlations with selected nutritional parameters. Methods: This observational analytic study included 195 cancer patients aged greater than 18 years at a university-affiliated hospital in Bangkok, Thailand. All patients were assessed for nutritional status by Thai PG-SGA in comparison to subjective global assessment (SGA). Anthropometry, body composition, and hand grip strength were evaluated. Results: According to PG-SGA global assessment categories, 39% (75) of 195 cancer patients were well nourished, 27% (53) were moderately malnourished and 34% (67) of patients were severely malnourished. Thai PG-SGA had a sensitivity of 99.1% and a specificity of 86.0% at predicting SGA classification. PG-SGA numerical scores were significantly different between well-nourished and malnourished groups (4.2 ± 2.4 Vs 16.3 ± 4.9; p < 0.001). The PG-SGA scores, nutritional status assessed by PG-SGA, and nutritional status assessed by SGA were correlated with weight, % weight loss in one month, body mass index, body fat, and hand grip strength (p < 0.001) respectively. Conclusions: Thai PG-SGA showed high sensitivity and good specificity in predicting malnutrition in Thai cancer patients. This tool demonstrated the correlations with anthropometric parameters, body composition, and muscle strength.

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