Prospective randomized trial to assess caloric and protein needs of critically Ill, anuric, ventilated patients requiring continuous renal replacement therapy

Scheinkestel, Carlos; Kar, L; Marshall, K; Bailey, Michael; Davies, Andrew R.; Nyulasi, Ibolya; Tuxen, David V.

doi:10.1016/s0899-9007(03)00175-8

Cited by 217 publications

(188 citation statements)

References 34 publications

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“…Additionally, an even higher delivery of dietary proteins may not be sufficient to obtain neutral or positive NB in situations of marked catabolism (41). In the literature, the association of this parameter with clinical prognosis in AKI patients on dialysis has been reported.…”

Section: Discussionmentioning

confidence: 99%

High-Volume Peritoneal Dialysis in Acute Kidney Injury

Ponce

Berbel

Góes

et al. 2012

Clinical Journal of the American Society of Nephrology

109

108

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Summary Background and objectives Peritoneal dialysis is still used for AKI in developing countries despite concerns about its limitations. The objective of this study was to explore the role of high-volume peritoneal dialysis in AKI patients in relation to metabolic and fluid control, outcome, and risk factors associated with death. Design, setting, participants, & measurements A prospective study was performed on 204 AKI patients who were assigned to high-volume peritoneal dialysis (prescribed Kt/V=0.60/session) by flexible catheter and cycler; 150 patients (80.2%) were included in the final analysis. Results Mean age was 63.8±15.8 years, 70% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (54.7%). BUN and creatinine levels stabilized after four sessions at around 50 and 4 mg/dl, respectively. Fluid removal and nitrogen balance increased progressively and stabilized around 1200 ml and −1 g/d after four sessions, respectively. Weekly delivered Kt/V was 3.5±0.68. Regarding AKI outcome, 23% of patients presented renal function recovery, 6.6% of patients remained on dialysis after 30 days, and 57.3% of patients died. Age and sepsis were identified as risk factors for death. In urine output, increase of 1 g in nitrogen balance and increase of 500 ml in ultrafiltration after three sessions were identified as protective factors. Conclusions High-volume peritoneal dialysis is effective for a selected AKI patient group, allowing adequate metabolic and fluid control. Age, sepsis, and urine output as well as nitrogen balance and ultrafiltration after three high-volume peritoneal dialysis sessions were associated significantly with death.

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Section: Discussionmentioning

confidence: 99%

High-Volume Peritoneal Dialysis in Acute Kidney Injury

Ponce

Berbel

Góes

et al. 2012

Clinical Journal of the American Society of Nephrology

109

108

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“…The total amount of nitrogen excreted per day was calculated from the sum of the amounts of nitrogen in the urine and dialysate. Urine was pooled for 24 h for the calculation of urinary excretion, which was calculated from urinary excretion levels and the volume of urine pooled for 24 h. Nitrogen loss in the dialysate was measured according to Scheinkestel's method; 20 mL dialysate was collected every 8 h, and the nitrogen level in the 24‐h dialysate was measured and calculated using a mixed sample of 60 mL in total based on the total volume of dialysate 9. Urea nitrogen was measured using a urease–glutamate dehydrogenase, isocitrate dehydrogenase, UV method with LABOSPECT 008 (Hitachi High‐Technologies, Tokyo, Japan) and reagent UN‐SL (Serotec, Hokkaido, Japan).…”

Section: Methodsmentioning

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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“…ЭП с низким содержанием белка было первоначально раз-работано для пациентов с почечной недостаточностью из-за широко распространенного мнения, что ограниче-ние приема белка замедляет прогрессирование заболе-вания почек. Однако клинические испытания показали, что пациенты в критическом состоянии с почечной недо-статочностью могут переносить применение белка до 2,5 г/кг в день [12]. Стандартная энтеральная смесь содер-жит около 40 г/1000 мл белка, с небелковой калорий-ностью к азоту приблизительно 1/130.…”

Section: составunclassified

Enteral Nutrition After Advadvanced Combined Operative Interventions in Oncosurgery

Нехаев¹,

Сытов²,

Ломидзе³

2016

Med. sov.

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Энтеральное питание (ЭП) -тип лечебного или дополнительного питания специальными смесями, при котором всасыва-ние пищи (при ее поступлении через рот, через зонд в желудке или кишечнике) осуществляется физиологически адекват-ным путем, то есть через слизистую оболочку желудочно-кишечного тракта. В данном обзоре будут рассмотрены такие аспекты энтерального питания (ЭП) у больных, находящихся в отделениях реанимации и интенсивной терапии (ОРИТ), как состав, компоненты, способы доставки, осложнения ЭП.

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Prospective randomized trial to assess caloric and protein needs of critically Ill, anuric, ventilated patients requiring continuous renal replacement therapy

Cited by 217 publications

References 34 publications

High-Volume Peritoneal Dialysis in Acute Kidney Injury

High-Volume Peritoneal Dialysis in Acute Kidney Injury

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

Enteral Nutrition After Advadvanced Combined Operative Interventions in Oncosurgery

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