Nutritional aspects in acute kidney injury

Berbel, Marina Nogueira; Pinto, Milene Peron Rodrigues; Ponce, Daniela; Balbi, André Luís

doi:10.1016/s2255-4823(11)70118-7

Cited by 13 publications

(11 citation statements)

References 33 publications

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“…Thinking of minimizing the impact of fluid overload on the incidence of AKI and, consequently, delaying diagnosis and worse outcomes, Macedo et al (16) and more recently Thongprayoon et al (17) proposed specific mathematical formulas for calculating creatinine in these patients. Furthermore, the influence of severe AKI on macronutrient metabolism favors hyper-catabolism, contributing to the fact that serum creatinine levels remain low (18).…”

Section: Discussionmentioning

confidence: 99%

Impact of timing of initiation of dialysis on mortality of patients with acute kidney injury

et al. 2020

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Introduction: In Brazil, primary studies on this issue are still limited and the ideal timing of initiation of dialysis in severe acute kidney injury (AKI) still generates disagreements among experts. Objectives: To assess if the timing of initiation of dialysis is associated with the mortality of patients with AKI in intensive care unit (ICU). Patients and Methods: We retrospectively analyzed medical records of patients that developed severe AKI in the ICU. Bivariate analysis was carried out to compare data between groups of patients who underwent early dialysis (ED - initiated up to two days after the AKI diagnosis) and late dialysis (LD – initiated more than two days after the AKI diagnosis), while multivariate logistic regression was applied to identify factors associated with mortality. Results: Of the 76 patients included in the study, 27 (35.5%) were allocated in the ED group and 49 (64.5%) in the LD group. LD group had a higher frequency of sepsis [26 (53%) vs. 12 (44%); P = 0.472], while the ED group had a higher median number of dialysis sessions (6 vs. 3; P = 0.477) and higher total median time on dialysis (17.5 h vs. 13 h; P = 0.629). The overall mortality rate was 61.8% (n = 47) and of 76% (n = 22) in the ED group. The patients’ serum creatinine level at admission in the ICU was the only statistically significant risk factor for death [OR= 0.453 (95% CI= 0.257–0.801); P = 0.006]. Conclusion: The overall and in the ED group mortality rate was elevated, however, the timing of initiation of dialysis did not show statistically significant association with death. The serum creatinine at ICU admission seems to be an important mortality predictor.

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Section: Discussionmentioning

confidence: 99%

Impact of timing of initiation of dialysis on mortality of patients with acute kidney injury

et al. 2020

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“…inflammatory state and altered fluid conditions. [42][43][44] However, considering the high prevalence of malnutrition in this population, that is, around 60% as a diagnosis of subjective global assessment, proper nutritional intervention is fundamental to minimize adverse prognosis in this population. 42,44 Among the existing methods, laboratory markers such as albumin, prealbumin, and cholesterol are most commonly used in clinical practice; however, these markers may be reduced independently of malnutrition, thus acting as acute phase markers.…”

Section: Estimating Catabolism In Acute Kidney Injurymentioning

confidence: 99%

“…[42][43][44] However, considering the high prevalence of malnutrition in this population, that is, around 60% as a diagnosis of subjective global assessment, proper nutritional intervention is fundamental to minimize adverse prognosis in this population. 42,44 Among the existing methods, laboratory markers such as albumin, prealbumin, and cholesterol are most commonly used in clinical practice; however, these markers may be reduced independently of malnutrition, thus acting as acute phase markers. 45,46 The total lymphocyte count has low specificity, while changes in body weight, an important measure of the nutritional routine of any patient, become unreliable in AKI, as the change in water status may overestimate the actual weight and show no loss of lean body mass.…”

Section: Estimating Catabolism In Acute Kidney Injurymentioning

confidence: 99%

“…Substitution with predictive formulas may overestimate the actual rate, given the difficulty in estimating the dry weight. 42,48 The Subjective Global Assessment is a nutritional diagnostic method established in AKI due to its association with important clinical outcomes; it is easily applied. 40,44 Although differences between evaluators can occur, nutritionist training can reduce the subjectivity errors inherent in the method.…”

Section: Estimating Catabolism In Acute Kidney Injurymentioning

confidence: 99%

“…Due to the lack of validation of the predictive equation specific for acute situations, there are very few studies in the literature that have used this tool for nutritional diagnosis and follow-up in AKI patients. 42…”

Section: Estimating Catabolism In Acute Kidney Injurymentioning

confidence: 99%

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Estimating Catabolism: A Possible Tool for Nutritional Monitoring of Patients With Acute Kidney Injury

Bufarah

Góes

Oliveira

et al. 2017

Journal of Renal Nutrition

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Hypercatabolism has been described as the main nutritional change in acute kidney injury. Catabolism may be defined as the excessive release of amino acids from skeletal muscle. Conditions such as fasting, inadequate nutritional support, renal replacement therapy, metabolic acidosis, and secretion of catabolic hormones are the main factors that affect protein catabolism. Given the imprecision of the methods conventionally used to assess and monitor the nutritional status of hospitalized patients, the parameters of protein catabolism, such as nitrogen balance, urea nitrogen appearance, and protein catabolic rate appear to be the main measures in this population. Considering the high prevalence of malnutrition in this population and important limitations in this clinical condition, such as the inflammatory state and altered fluid, catabolism parameters are accurate and reliable methods that could contribute to minimize adverse prognosis in this population.

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Hypoalbuminemia at admission predicts the development of acute kidney injury in hospitalized patients: A retrospective cohort study

Lee

Baek

et al. 2017

PLoS ONE

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BackgroundDevelopment of acute kidney injury (AKI) is common and is associated with poor outcomes. We aimed to determine whether hypoalbuminemia (HA) at admission could be a risk factor for the development of AKI and mortality in hospitalized patients.MethodsWe enrolled patients who were admitted to Seoul National University Bundang Hospital from January 2013 to December 2013. HA at admission was defined as a serum albumin level < 3.4 mg/dL measured within two days after admission. AKI was defined as an increase in the serum creatinine level by ≥0.3 mg/dL or ≥1.5 times of the baseline value during the hospital stay.ResultsA total of 19,472 patients were enrolled and divided into HA and normoalbuminemia (NA) groups at admission. The incidence of AKI was 10.7% (340/3179) in the HA group and 4.1% (662/16293) in the NA group (adjusted odds ratio [OR], 1.243; 95% confidence interval [CI], 1.069–1.445; P = 0.005). The hazard ratios for the 30-day, 90-day, and 1-year mortality were 1.873 (95% CI, 1.383–2.537; P < 0.001), 1.710 (95% CI, 1.410–2.072; P < 0.001), and 1.372 (95% CI, 1.214–1.551; P < 0.001), compared to the NA group. In patients with AKI, albumin replacement improved renal recovery (OR, 2.605; 95% CI, 1.450–4.681; P = 0.001). The mortality rate was not different according to albumin replacement.ConclusionsHA is associated with the development of AKI and high mortality in hospitalized patients. Replacement of albumin after the development of AKI may contribute to renal recovery. Further clinical trials are warranted.

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Nutritional aspects in acute kidney injury

Cited by 13 publications

References 33 publications

Impact of timing of initiation of dialysis on mortality of patients with acute kidney injury

Impact of timing of initiation of dialysis on mortality of patients with acute kidney injury

Estimating Catabolism: A Possible Tool for Nutritional Monitoring of Patients With Acute Kidney Injury

Hypoalbuminemia at admission predicts the development of acute kidney injury in hospitalized patients: A retrospective cohort study

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