Nutritional parameters are associated with mortality in acute kidney injury

Abstract

OBJECTIVE:The objective of this study was to perform a nutritional assessment of acute kidney injury patients and to identify the relationship between nutritional markers and outcomes.METHOD:This was a prospective and observational study. Patients who were hospitalized at the Hospital of Botucatu School of Medicine were evaluated between January 2009 and December 2011. We evaluated a total of 133 patients with a clinical diagnosis of acute kidney injury and a clinical presentation suggestive of acute tubular necrosis. We explored the associations between clinical, laboratory and nutritional markers and in-hospital mortality. Multivariable logistic regression was used to adjust for confounding and selection bias.RESULTS:Non-survivor patients were older (67±14 vs. 59±16 years) and exhibited a higher prevalence of sepsis (57.1 vs. 21.4%) and higher Acute Tubular Necrosis-Individual Severity Scores (0.60±0.22 vs. 0.41±0.21) than did survivor patients. Based on the multivariable analysis, laboratorial parameters such as blood urea nitrogen and C-reactive protein were associated with a higher risk of death (OR: 1.013, p = 0.0052; OR: 1.050, p = 0.01, respectively), and nutritional parameters such as low calorie intake, higher levels of edema, lower resistance based on bioelectrical impedance analysis and a more negative nitrogen balance were significantly associated with a higher risk of death (OR: 0.950, p = 0.01; OR: 1.138, p = 0.03; OR: 0.995, p = 0.03; OR: 0.934, p = 0.04, respectively).CONCLUSIONS:In acute kidney injury patients, a nutritional assessment seems to identify nutritional markers that are associated with outcome. In this study, a low caloric intake, higher C-reactive protein levels, the presence of edema, a lower resistance measured during a bioelectrical impedance analysis and a lower nitrogen balance were significantly associated with risk of death in acute kidney injury patients.

Immunonutrition Is Associated With a Decreased Incidence of Graft‐Versus‐Host Disease in Bone Marrow Transplant Recipients: A Meta‐Analysis

“…Badjatia et al performed a prospective observational study in patients recovering from subarachnoid hemorrhages and noted that patients who developed negative nitrogen balance developed more hospital‐acquired infections (hazard ratio 1.04, 95% CI: 1.0–1.08, P = .043) 52 . In a prospective observational study of patients with acute kidney injury, Berbel et al similarly reported that negative nitrogen balance was associated with a higher risk of mortality (odds ratio = 0.934, 95% CI: 0.872–1.000, P = .04) 53 . Despite these proposed mechanisms, subgroup analysis in this current meta‐analysis failed to identify glutamine supplementation as superior to nonglutamine varieties of immunonutrition.…”

Effects of Hypocaloric Versus Normocaloric Nutrition on Renal Functions and Outcomes in Intensive Care Unit Patients

“…Yine bu çalışma ile sonuç olarak hastaların genel olarak düşük kalori alımına sahip oldukları ve ancak daha yüksek kalori alan grubun da daha iyi klinik sonuçlarla (RRT'den ayrı gün, ventilatörden ayrı gün vs.) ilişkili olmadığı sonucuna varılmıştır (16). Berbel ve arkadaşları ise daha az sayılı çalışmalarında AKI olan hastalarda HN'nin yüksek mortalite ile ilişkili olduğunu (Odds Ratio (OR): 1,050, p=0,01), kreatinin ve BUN değerlerinin düşük kalori alımı olan hastalarda daha yüksek seyrettiğini öne sürmüşlerdir (p=0,03 ve OR:1,013 -p=0,005) (17). Bizim hastalarımızda da BUN ve kreatin değerlerinde hipokalorik grupta artış olsa da normokalorik gruba göre daha az oranda (%17,6) SRRT uygulanmış ancak istatistiksel olarak anlamlı fark izlenmemiştir (p=0,643).…”

Acute Kidney Injury Masked by Malnutrition: A Case Report and the Problem of Protein

“…This question has clinical significance, as there are risks to providing too little as well as too much protein in this patient population. Negative nitrogen balance has been associated with increased mortality risk among critically ill patients with AKI . Additionally, studies have shown that actual nutrition support provision (particularly with enteral feedings) is often significantly less than what is prescribed by a clinician .…”

“…Negative nitrogen balance has been associated with increased mortality risk among critically ill patients with AKI. 47 Additionally, studies have shown that actual nutrition support provision (particularly with enteral feedings) is often significantly less than what is prescribed by a clinician. 33,34 For this reason, and the increased catabolism that is associated with critical illness and its myriad of comorbid conditions, the risk of malnutrition in the ICU is high.…”