High Protein Intake during Continuous Hemodiafiltration: Impact on Amino Acids and Nitrogen Balance

Bellomo, Rinaldo; Tan, Han Khim; Bhonagiri, Deepak; Gopal, I.; Seacombe, J.; Daskalakis, Michael; Boyce, Neil

doi:10.1177/039139880202500403

Cited by 111 publications

(91 citation statements)

References 19 publications

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“…Authors [2,3] and guidelines [1,6] continue to recommend a protein intake of at least >1 g/kg/day in AKI patients, but the evidence supporting such recommendations is weak [7,8,9,10,11,12,13]. Moreover, although such recommendations appear reasonable from a nitrogen-balance point of view, especially given the loss of amino acids during CRRT [21,22,23,24,25,26,27], the only randomized controlled trial focusing on clinical outcomes was conducted in 1973 [28] and has little relevance to modern practice.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, all studies of protein intake in AKI conducted so far have been small and single center [7,8,9,10,11,12,13]. Thus, there are no large multicenter observational studies to (a) describe current practice and (b) assess whether protein intake in patients receiving renal replacement therapy (RRT) carries an independent association with patient-centered outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Daily Protein Intake and Patient Outcomes in Severe Acute Kidney Injury: Findings of the Randomized Evaluation of Normal versus Augmented Level of Replacement Therapy (RENAL) Trial

et al. 2014

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Background and Aims: We aimed to examine the association between dailyprotein intake (DPI) and outcomes in patients from the Randomized Evaluation of Normal versus Augmented Level (RENAL) trial. Methods: We analyzed the association between DPI and clinical outcomes using multivariable logistic regression, Cox proportional hazards models and time-adjusted analysis. Results: During ICU stay, mean DPI was 37.6 g/day among survivors and 37.7 g/day among nonsurvivors (p = 0.96; DPI of 0.5 g/kg/day). Only 159 (10.9%) of the patients received a mean DPI of >1 g/kg. Patients with a DPI above the median had a 43.1% mortality compared with 46.1% for a DPI below the median (p = 0.25). On multivariate analysis, a lower DPI was not associated with increased odds ratios for 90-day mortality or any secondary outcomes. Cox proportional hazards models and time-adjusted analysis confirmed these findings. Conclusions: In the RENAL study, mean DPI was low. Within the confines of such low DPI, greater amounts of DPI were not independently associated with improved clinical outcomes. Video Journal Club “Cappuccino with Claudio Ronco” at www.karger.com/?doi=363175.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Daily Protein Intake and Patient Outcomes in Severe Acute Kidney Injury: Findings of the Randomized Evaluation of Normal versus Augmented Level of Replacement Therapy (RENAL) Trial

et al. 2014

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“…When this device cannot be used, it is recommended to provide an energy target of 20-30 kcal/kg/day and a protein target of 1.5 g/kg/day, in the absence of RRT [219]. In case of RRT, an increase in protein supply including glutamine and micronutrients (vitamins and trace elements) is suggested [220]. Water-soluble vitamins from the B group (especially B1 vitamins and folates) are significantly eliminated during RRT [221].…”

Section: (Grade 1−) Strong Agreementmentioning

confidence: 99%

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai

Vinsonneau

Souweine

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall.

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“…HVHF has important limitations such as a theoretical depletion of low-molecular-weight molecules (nutrients, vitamins, trace elements, and drugs such as antibiotics), an elevated cost due mainly to the requirement of large replacement fluid amounts, and a high nursing workload [38,39]. Cascade hemofiltration was recently developed to limit some of these drawbacks [40].…”

Section: High-volume Hemofiltrationmentioning

confidence: 99%

Clinical review: Blood purification for sepsis

2011

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Sepsis is the primary cause of death in the intensive care unit. Extracorporeal blood purification therapies have been proposed for patients with sepsis in order to improve outcomes since these therapies can alter the host inflammatory response by non-selective removal of inflammatory mediators or bacterial products or both. Recent technological progress has increased the number of techniques available for blood purification and their performance. In this overview, we report on the latest advances in blood purification for sepsis and how they relate to current concepts of disease, and we review the current evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration, and high-cutoff hemofiltration/hemodialysis. Promising results have been reported with all of these blood purification therapies, showing that they are well tolerated, effective in clearing inflammatory mediators or bacterial toxins (or both) from the plasma, and efficacious for improvement of various physiologic outcomes (for example, hemodynamics and oxygenation). However, numerous questions, including the timing, duration, and frequency of these therapies in the clinical setting, remain unanswered. Large multicenter trials evaluating the ability of these therapies to improve clinical outcomes (that is, mortality or organ failure), rather than surrogate markers such as plasma mediator clearance or transient improvement in physiologic variables, are required to define the precise role of blood purification in the management of sepsis.

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High Protein Intake during Continuous Hemodiafiltration: Impact on Amino Acids and Nitrogen Balance

Abstract: High protein intake increases the serum concentrations of most amino acids. Such protein supplementation, when coupled with CVVHDF achieves a slightly negative overall nitrogen balance in extremely catabolic patients while still allowing adequate azotemic control.

Cited by 111 publications

References 19 publications

Daily Protein Intake and Patient Outcomes in Severe Acute Kidney Injury: Findings of the Randomized Evaluation of Normal versus Augmented Level of Replacement Therapy (RENAL) Trial

Daily Protein Intake and Patient Outcomes in Severe Acute Kidney Injury: Findings of the Randomized Evaluation of Normal versus Augmented Level of Replacement Therapy (RENAL) Trial

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Clinical review: Blood purification for sepsis

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