Metabolic and Nutritional Aspects of Acute Renal Failure in Critically Ill Patients Requiring Continuous Renal Replacement Therapy

Abstract

Acute renal failure (ARF) is rarely an isolated process but is often a complication of underlying conditions such as sepsis, trauma, and multiple-organ failure in critically ill patients. As such, concomitant clinical conditions significantly affect patient outcome. Poor nutritional status is a major factor in increasing patients' morbidity and mortality. Malnutrition in ARF patients is caused by hypercatabolism and hypermetabolism that parallel the severity of illness. When dialytic intervention is indicated, continuous renal replacement therapy (CRRT) is a commonly used alternative to intermittent hemodialysis because it is well tolerated by hemodynamically unstable patients. This paper reviews the metabolic and nutritional alterations associated with ARF and provides recommendations regarding the nutritional, fluid, electrolyte, micronutrient, and acid-base management of these patients. The basic principles of CRRT are addressed, along with their nutritional implications in critically ill patients. A patient case is presented to illustrate the clinical application of topics covered within the paper.

Precision Continuous Renal Replacement Therapy and Solute Control

“…In this circumstance, the prescribed CRRT dose can be increased to achieve the new solute control target. clears low molecular weight water-soluble substances, significant loss of glucose, amino acids, low molecular weight proteins, vitamins and trace elements also occur [21,22] . CRRT delivered dose also has the inadvertent consequence of increasing drug clearances and can result in the potential suboptimal dosing of antimicrobials [23,24] .…”

Nutrition Support among Critically Ill Children with AKI

“…Patients with AKI are at high risk of malnutrition, and the presence of malnutrition in the context of AKI has been linked to increased morbidity and mortality (5)(6)(7). Almost half of adult patients with AKI have severe malnutrition on admission to the ICU (6).…”

Continuous venovenous hemodiafiltration trace element clearance in pediatric patients: a case series

“…Compared with intermittent hemodialysis, the continuous nature of CRRT has the advantage of removing fluids and solutes slowly and consistently with less likelihood of causing hemodynamic compromise [2]. CRRT allows the provision of adequate nutrition to meet the requirements of catabolism in pediatric AKI patients because of its expanded capacity to remove fluid and nitrogenous waste products [3]. Although CRRT accommodates the parenteral administration of large volumes of fluid and nutrition, it also removes nutritional solutes and drugs from plasma.…”