Enteral nutrition in patients with acute renal failure

Fiaccadori, Enrico; Maggiore, Umberto; Giacosa, Roberto; Rotelli, Carlo; Picetti, Edoardo; Sagripanti, Sibilla; Melfa, Luigi; Meschi, Tiziana; Borghi, Loris; Cabassi, Aderville

doi:10.1111/j.1523-1755.2004.00459.x

Cited by 81 publications

(45 citation statements)

References 31 publications

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“…This finding is similar to the results published in critically ill adult patients with acute renal failure (Fiaccadori et al, 2004). The higher incidence of complications in patients with acute renal failure could be due the gastrointestinal motility disorders associated with the uremia (Van Vlem et al, 2000) and/or the greater clinical severity of patients with acute renal failure indicated by the higher incidence of shock, the need for high drugs of vasoactive doses and multiorgan failure (Fernández et al, 2005).…”

Section: Discussionsupporting

confidence: 88%

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

et al. 2007

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Objective: To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children. Design: A prospective, observational study. Setting: Pediatric intensive care unit Subjects: Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN). Methods: Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications Results: Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 mg/kg/min and hypophosphatemia. Conclusions: The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.

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Section: Discussionsupporting

confidence: 88%

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

et al. 2007

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“…ABH'da enteral beslenmeye dair veriler kısıtlıdır. Nazogastrik tüp yoluyla verilen beslenme desteğinin güvenilirlik ve etkinliği 182 ABH'lı hastada değerlendirilmiş ve ABH ile GI, mekanik veya metabolik komplikasyonlarda artış arasında bir ilişki saptanmamıştır (41). Yüksek gastrik rezidüel volüm böbrek fonksiyonu normal hastalarla karşılaştırıldığında ABH'lı hastalarda daha sık gözlenmiştir.…”

Section: Eser Elementlerunclassified

“…Bu formüllerin dezavantajı protein konsantrasyonunun daha düşük ve bazı elektrolit düzeylerinin (potasyum, fosfat) daha yüksek olmasıdır. Kronik böbrek yetmezliği olan hastalar için düzenlenmiş formüller ABH'lı hastalarda da kullanılabilir (41). Bu formüller, standart formüllerin birçoğu ile karşılaştı-rıldığında, daha yüksek kalori, daha düşük elektrolit içeriği ve bazılarında daha yüksek protein oranı ile karakterizedir.…”

Section: Eser Elementlerunclassified

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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“…However, when patients are unable to consume adequate nutrition, tube feedings may be implemented. In an observational study by Fiaccadori et al [45], EN-related complications and the adequacy of nutrient administration during 2525 days of EN were compared in 247 consecutive patients fed exclusively by the enteral route (65 normal renal function, 68 AKI not requiring RRT, 114 AKI requiring RRT). The investigators found no difference in gastrointestinal or mechanical complications between AKI patients and patients with normal renal function, except for high gastric residual volumes (not defined), which occurred in 3.1% of patients with normal renal function, 7.3% of patients with AKI not requiring RRT, 13.2% of patients with AKI requiring RRT (P = 0.02 for trend), and for nasogastric tube obstruction: 0.0%, 5.9%, 14%, respectively (P < 0.001).…”

mentioning

confidence: 99%

“…EN was safe and effective in patients with AKI. In patients experiencing intolerance to gastric feedings, clinicians are encouraged to try small-bowel feedings [45]. !…”

mentioning

confidence: 99%

Nutrition support therapy in acute kidney injury: Distinguishing dogma from good practice

Gervasio

Cotton²

2009

Curr Gastroenterol Rep

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!Acute kidney injury (AKI) is a frequently observed complication in critically ill patients. Its presentation may range from the early risk of renal dysfunction to complete renal failure. Morbidity and mortality in the AKI patient increase with the decline of renal function. Appropriate nutrition therapy is essential in the medical management of the AKI patient. Assessment of nutritional requirements should take into account the patient's underlying complication, comorbid medical conditions, and severity of the renal dysfunction. Various stages of AKI determine the direction of nutrition therapy. Additionally, understanding the macro-and micronutrient modifications and electrolyte and vitamin alterations that should be implemented are vital for better patient outcomes.

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Enteral nutrition in patients with acute renal failure

Abstract: Enteral nutrition is a safe and effective nutritional technique to deliver artificial nutrition in ARF patients. Parenteral amino acid supplementation may be required, especially in patients with ARF needing renal replacement therapy.

Cited by 81 publications

References 31 publications

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

Nutritional Support in Acute Kidney Injury

Nutrition support therapy in acute kidney injury: Distinguishing dogma from good practice

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