Amino Acid Requirements in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy

Btaiche, Imad F.; Mohammad, Rima A.; Alaniz, Cesar; Mueller, Bruce A.

doi:10.1592/phco.28.5.600

Cited by 68 publications

(71 citation statements)

References 74 publications

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“…A similar finding of deranged protein metabolism is also well recognized in patients with ARF, especially in those receiving dialysis therapy (14). Among the various types of dialysis therapy, CRRT engenders a greater loss of amino acids (14 -16).…”

Section: Discussionmentioning

confidence: 62%

Sustained Low Efficiency Dialysis in the Continuous Mode (C-SLED)

Salahudeen¹,

Kumar²,

Madan³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Oliguric, hypotensive patients who require large amounts of fluids may benefit from sustained low-efficiency dialysis performed continuously (C-SLED). C-SLED through higher clearance may improve survival, or through greater nutritional loss may worsen survival. No studies have assessed survival on C-SLED. The objective was to examine patient outcomes and survival predictors on C-SLED.Design, setting, participants, & measurements: The data of 199 consecutive cancer patients treated with C-SLED were analyzed. The median duration of C-SLED was 50 h. With 48 h of C-SLED, the blood urea nitrogen (BUN) and serum creatinine levels had decreased by 80% and 73%, respectively. The mean arterial pressure (MAP) was maintained despite higher ultrafiltration and reduced vasopressor use. The 30-d mortality rate was 65%. Despite excellent dialysis, the sequential organ failure assessment (SOFA) score remained predictive of mortality. In the univariate model, higher SOFA scores and lower values for MAP, blood pH, and serum albumin and creatinine levels were associated with higher mortality. Administration of total parenteral nutrition (TPN) was, however, associated with lower mortality.Results: In the multivariate model, the higher SOFA score and lower blood pH, MAP and C-SLED duration were associated with higher mortality. In a subset analysis of 129 patients who received C-SLED for at least 48 h, those with higher BUN levels, which were associated with higher TPN infusion, had a lower mortality risk.Conclusion: This first detailed report on C-SLED indicates that C-SLED can be effective and suggests a link between nutrition and survival.

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Section: Discussionmentioning

confidence: 62%

Sustained Low Efficiency Dialysis in the Continuous Mode (C-SLED)

Salahudeen¹,

Kumar²,

Madan³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Moreover, patients with AKI requiring renal replacement therapy lose nitrogen into dialysate and require greater protein intake compared with patients not receiving renal replacement therapy,5 with recommended energy intakes of 30–35 kcal/kg per day and protein intakes of 1.5–2.0 g/kg per day 6. Although previous studies have reported improved nitrogen balance with the administration of up to 2.5 g/kg per day amino acids, the efficacy of this supplementation for improving outcomes in critically ill patients with AKI remains unclear 7, 8. In addition, the dynamics of nitrogen loss through a dialysis membrane also remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Relationship between nitrogen loss and blood urea nitrogen concentrations in patients requiring continuous renal replacement therapy

Sato

Kushimoto

2016

Acute Medicine & Surgery

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AimIt is well known that continuous renal replacement therapy (CRRT) produces some amount of nitrogen loss, but there are few tools that are easily applied to measure it. This study aimed to evaluate nitrogen loss using blood urea nitrogen (BUN) measurement in patients receiving CRRT.MethodsThe subjects were 28 patients who received CRRT (except for liver failure) between 2010 and 2012. Nutrition data and nitrogen excretion in dialysate and urine were measured.ResultsThe median age of the patients was 61 years, with an Acute Physiology and Chronic Health Evaluation score of 27 points and a Sequential Organ Failure Assessment score of 12 points. All‐cause hospital mortality was 50%. Median protein intake was 40 g/day. The daily urinary volume was 245 mL and volume of dialysate was 26,000 mL/day. The median amount of nitrogen loss was 10.58 g/day, with BUN showing a strong correlation (r = 0.804, P < 0.0001). There was a poor relation between protein intake (g/kg body weight) and nitrogen balance (r = 0.322, P = 0.002).ConclusionsIn patients receiving CRRT, the nitrogen loss showed a positive correlation with BUN but not with protein intake. According to the guidelines, recommended protein intake was 1.5–2.0 g/kg/day, but we should be careful to avoid elevating BUN at the same time. The results showed that BUN might be a useful marker to check nitrogen balance in the nutritional management of patients receiving CRRT.

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“…Genellikle diğer organ yetmezlikleriyle birlikte görülür ve çoklu organ yetmezliğinin tedavi stratejisinin temel taşlarında biri de yeterli beslenme desteğidir (9,10 ancak protein alımında dalgalanmalar ve katabolik durumdaki değişiklikler hatalı sonuçlara neden olabilir (16,17).…”

Section: Introductionunclassified

Nutritional Support in Acute Kidney Injury

Bilgic¹,

Akçay²,

Sezer³

2013

turk Neph Dial Transpl

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ÖZAkut böbrek hasarı (ABH), hastanede yatan hastalarda oldukça sık karşılaşılan bir komplikasyondur ve morbidite ve mortalitede artış ile ilişkilidir. ABH nadiren izole organ yetmezliği olarak görülür, daha sıklıkla kritik hastalık olarak tanımlanan ciddi ve uzamış katabolik faz ile karakterize çoklu organ yetmezliği sendromunun bir parçası olarak ortaya çıkar. ABH'lı hastalar sıklıkla protein-enerji tüketimi içindedir ki bu önemli bir olumsuz prognostik faktördür. Akut böbrek hasarlı hastalarda malnütrisyon, komplikasyon gelişme riski, hospitalizasyon süresi ve hastane mortalitesinde artış ile ilişkilidir. Bu nedenle ABH'lı hastaların tedavisinde uygun beslenme desteğinin yer alması elzemdir. Beslenme gereksinimi değerlendirilirken hastanın altta yatan hastalığı, komorbid durumları ve böbrek fonksiyon bozukluğunun ciddiyeti ile renal replasman tedavisi (RRT) ihtiyacı dikkate alınmalıdır. ABH'da beslenme desteğinin esas amacı, normal böbrek fonksiyonuna sahip kritik hastalar için önerilene benzerdir: yeterli miktarda besin öğesi sağlandığından emin olmak, metabolik komplikasyonlara eşlik eden protein-enerji tüketimini önlemek ve mortaliteyi azaltmak. ABH, aynı hastanın bile klinik takip süresince büyük ölçüde değişen beslenme ihtiyacına sahip olduğu oldukça heterojen bir hasta grubunu kapsadığından beslenme gereksinimi açısından değerlendirme aralıklı olarak tekrar edilmeli, bireyselleştirilmeli ve RRT ile bütünleştirilmelidir.. AnAhtAR SÖZcüKLER: Akut böbrek hasarı, Beslenme değerlendirmesi, Beslenme tedavisi ABStRActAcute kidney injury (AKI) is a frequent complication affecting many hospitalized patients and is associated with increased morbidity and mortality. AKI seldom occurs as isolated organ failure; much more often it emerges as a component of the multiple organ failure syndrome, within the framework of the severe-prolonged catabolic phase determined by critical illness. Patients with AKI often have protein-energy wasting, which represents a major negative prognostic factor. Malnutrition in AKI patients is associated with increased risk of complications, longer hospitalization, and higher hospital mortality. Hence, appropriate nutritional support is essential in the management of the AKI patient. Assessment of nutritional requirements should take into account the patient's underlying disease, comorbid medical conditions, severity of the renal dysfunction and need for RRT. The primary goals of nutritional support in AKI are the same as those suggested for critically ill patients with normal renal function: to ensure the delivery of adequate amounts of nutrients, to prevent protein-energy wasting with the attendant metabolic complications, to reduce mortality. Since AKI comprises a highly heterogeneous group of subjects with nutrient needs widely varying even along the clinical course in the same patient, nutritional requirements should be frequently reassessed, individualized and carefully integrated with RRT..

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Amino Acid Requirements in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy

Cited by 68 publications

References 74 publications

Sustained Low Efficiency Dialysis in the Continuous Mode (C-SLED)

Sustained Low Efficiency Dialysis in the Continuous Mode (C-SLED)

Relationship between nitrogen loss and blood urea nitrogen concentrations in patients requiring continuous renal replacement therapy

Nutritional Support in Acute Kidney Injury

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