Low caloric and protein intake is associated with mortality in patients with acute kidney injury

Bufarah, Marina Nogueira Berbel; Costa, Nara Aline; Losilla, Milene Peron Rodrigues; Reis, Nayrana Soares Carmo; Silva, M.Z.C.; Balbi, André Luís; Ponce, Daniela

doi:10.1016/j.clnesp.2018.01.012

Cited by 15 publications

(34 citation statements)

References 23 publications

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“…For serum total cholesterol, the mean or median reported by four studies ranged from 101 to 139 mg/dL. Two studies found no significant association between serum total cholesterol and in-hospital mortality [21,22]. Similarly, Xie et al [35] reported that serum total cholesterol (per 3 mg/dL decrease) was not associated with 90-day mortality.…”

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

“…The mean or median of serum albumin reported was ranging from 2.4 to 3.4 g/dL. Two studies showed that serum albumin was not associated with either mortality [33] or in-hospital mortality [21], whilst another two studies reported otherwise [22,31]. Contradictory findings on the association between serum albumin and 60-day mortality were noted in two studies [23,32], while one study reported a significant association between serum albumin and 28-day mortality [25].…”

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

“…Similarly, protein intake >1 g/kg/day was not also associated with mortality. Contrarily, two studies showed that energy intake was associated with~5% lower risk of in-hospital mortality [21,22]. As for dietary protein intake, one study each found that protein intake was associated lower risk of in-hospital mortality (OR: 0.947; 95% CI: 0.988-0.992; p = 0.028) [22] and 28-day mortality (HR: 0.993, 95% CI: 0.987-0.999, p = 0.032) [24], respectively.…”

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

“…Contrarily, two studies showed that energy intake was associated with~5% lower risk of in-hospital mortality [21,22]. As for dietary protein intake, one study each found that protein intake was associated lower risk of in-hospital mortality (OR: 0.947; 95% CI: 0.988-0.992; p = 0.028) [22] and 28-day mortality (HR: 0.993, 95% CI: 0.987-0.999, p = 0.032) [24], respectively. However, it is important to note that the upper limits of 95% CI of these studies [21,22,24] were very close to 1.00, therefore, the clinical significance remains unclear.…”

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

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Protein-Energy Wasting Assessment and Clinical Outcomes in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

et al. 2020

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Nutritional assessment is essential to identify patients with acute kidney injury (AKI) who are protein-energy wasting (PEW) and at risk of poor clinical outcomes. This systematic review aimed to investigate the relationship of nutritional assessments for PEW with clinical outcomes in patients with AKI. A systematic search was performed in PubMed, Scopus, and Cochrane Library databases using search terms related to PEW, nutrition assessment, and AKI to identify prospective cohort studies that involved AKI adult patients with at least one nutritional assessment performed and reported relevant clinical outcomes, such as mortality, length of stay, and renal outcomes associated with the nutritional parameters. Seventeen studies reporting eight nutritional parameters for PEW assessment were identified and mortality was the main clinical outcome reported. A meta-analysis showed that PEW assessed using subjective global assessment (SGA) was associated with greater mortality risk (RR: 1.99, 95% CI: 1.36–2.91). Individual nutrition parameters, such as serum chemistry, body mass, muscle mass, and dietary intakes, were not consistently associated with mortality. In conclusion, SGA is a valid tool for PEW assessment in patients with AKI, while other nutrition parameters in isolation had limited validity for PEW assessment.

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Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

Section: Nutritional Assessment Of Pew and Clinical Outcomesmentioning

confidence: 99%

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Protein-Energy Wasting Assessment and Clinical Outcomes in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

et al. 2020

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Nutrition support for critically ill patients

Al‐Dorzi

Arabi

2021

J Parenter Enteral Nutr

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Nutrition support is an important aspect of the management of critically ill patients.This review highlights the emerging evidence on critical care nutrition and focuses on the pathophysiologic interplay between critical illness, the gastrointestinal tract, and nutrition support and the evidence on the best route, dose, and timing of nutrition.Although indirect calorimetry is recommended to measure energy expenditure, predictive equations are commonly used but are limited by their inaccuracy in individual patients. The current evidence supports early enteral nutrition (EN) in most patients, with a gradual increase in the daily dose over the first week. Delayed EN is warranted in patients with severe shock. According to recent trials, parenteral nutrition seems to be as effective as EN and may be started if adequate EN is not achieved by the first week of critical illness. A high protein dose has been recommended, but the best timing is unclear. Immuno-nutrition should not be routinely provided to critically ill patients.Patients receiving artificial nutrition should be monitored for metabolic derangements.

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May nutritional status worsen during hospital stay? A sub-group analysis from a cross-sectional study

et al. 2018

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Hospital malnutrition is a detrimental prognostic factor regarding hospital mortality, complications, and length of stay. However, the role of hospitalization itself on nutritional status has not been fully elucidated. We report the results of a secondary analysis from the dataset of a recent cross-sectional study at Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Data from patients evaluated at admission and discharge were collected and compared. One hundred thirty-nine patients were evaluated. Mean length of stay was 13.6 (± 7.7) days. Patients at risk of malnutrition, according to NRS-2002, were 75 (53.9%), while 63 (45.3%) were malnourished according to ESPEN Criteria. Compared to admission, at discharge, patients reported a significant decrease in Mid-Upper Arm Circumference (MUAC)-from 26.5 cm (± 3.6) to 25.9 cm (± 3.7) (p = 0.016), a reduction in Phase angle (PhA)-from 4.25° (± 1.20) to 4.01° (± 1.15) (p = 0.005), fat-free mass (FFM)-from 47.5 kg (± 9.19) to 44.9 kg (± 9.4) (p = 0.03) and fat-free mass index (FFMI)-from 16.9 kg/m (± 2.3) to 15.8 kg/m (± 2.7) (p = 0.04). Laboratory data showed a reduction of albumin-from 29.2 (± 5.7) to 28.0 (± 5.9) (p = 0.01) and Onodera's PNI- from 29.1 (± 5.6) to 27.6 kg (± 5.6) (p = 0.039). At the multivariate linear regression analysis, the variables significantly associated with a worsening of PhA at discharge are the PhA value at admission and the diagnosis of malnutrition according to ESPEN Criteria. Hospitalization leads to significative changes in nutritional status. A clinical concern should be raised about the quality of hospital food and meal times and on the need for a clinical nutritionist on the ward.

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Low caloric and protein intake is associated with mortality in patients with acute kidney injury

Cited by 15 publications

References 23 publications

Protein-Energy Wasting Assessment and Clinical Outcomes in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

Protein-Energy Wasting Assessment and Clinical Outcomes in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

Nutrition support for critically ill patients

May nutritional status worsen during hospital stay? A sub-group analysis from a cross-sectional study

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