Nitrogen Balance in Postsurgical Patients with Acute Renal Failure on Continuous Arteriovenous Hemofiltration and Total Parenteral Nutrition1

Chima, Cinda S.; Meyer, Lori A.; Heyka, Robert; Bosworth, Cindy; Hummel, Aurélie; Weryński, Andrzej; Paganini, Emil P.; Verdi, P.

doi:10.1159/000420182

Cited by 25 publications

(37 citation statements)

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“…Patients with acute renal failure have very high protein catabolic rates (21,22). Therefore, they may require high dialytic clearances to achieve adequate metabolic control.…”

Section: Discussionmentioning

confidence: 99%

Comparison of solute clearance in three modes of continuous renal replacement therapy

Parakininkas

Greenbaum

2004

Pediatric Critical Care Medicine

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CVVHD was superior to predilution CVVH for clearance of urea and creatinine. Postdilution CVVH and CVVHD gave nearly equivalent clearances. At the low blood flow rates used in pediatric patients, which raise concerns about high ultrafiltration during postdilution CVVH causing excessive hemoconcentration and filter clotting, CVVHD appears to be the optimal modality for maximizing clearance of small solutes during CRRT.

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“…Patients with acute renal failure have very high protein catabolic rates (21,22). Therefore, they may require high dialytic clearances to achieve adequate metabolic control.…”

Section: Discussionmentioning

confidence: 99%

Comparison of solute clearance in three modes of continuous renal replacement therapy

Parakininkas

Greenbaum

2004

Pediatric Critical Care Medicine

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“…Chima et al [37] measured the protein catabolic rate, urea nitrogen appearance, and total nitrogen appearance in 19 critically ill patients with ARF treated with continuous hemofiltration. A mean protein catabolic rate of 1.7 g/kg BW per day was observed and it was concluded that these patients' needs ranged between 1.4 and 1.7 g protein/kg BW per day.…”

Section: Amino Acid and Protein Requirements In Patients With Arfmentioning

confidence: 99%

Protein Metabolism in Acute Renal Failure

Druml

1997

Mineral Electrolyte Metab

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The hallmark of metabolic alterations in acute renal failure (ARF) is accelerated protein breakdown which, unfortunately, cannot be suppressed effectively by provision of exogenous nutritional substrates. Causes of excessive protein catabolism are manifold and present a combination of unspecific mechanisms induced by the acute disease process and underlying illness or associated complications, effects induced by the acute loss of renal function and, finally, the type and intensity of renal replacement therapy. Specific uremic toxic effects, insulin resistance, hormonal derangements, metabolic acidosis, circulating proteases, inflammatory mediators, and dialysis-related losses of nutritional substrates all contribute to the activation of protein degradation. Metabolism in ARF is also affected by an impairment of the multiple metabolic and endocrine functions of the kidney. Various amino acids are synthesized or interconverted by the kidneys and may become conditionally indispensable. The kidney is also an important organ in the degradation of peptides, such as peptide hormones. As a consequence of these metabolic aberrations, imbalances in amino acid pools in plasma and in the intracellular compartment occur in ARF and elimination and utilization of infused amino acids is altered. Protein or amino acids requirements are influenced more by the nature of the illness causing ARF, by the extent of hypercatabolism, by associated complications, and by the type and frequency of renal replacement therapy than by renal dysfunction per se. In noncatabolic patients, an intake of 1 g/kg body weight per day may be sufficient, while in critically ill hypercatabolic patients undergoing continuous renal replacement therapy, 1.5 g amino acids/kg body weight per day should be provided to minimize nitrogen losses. For the future, we need to identify safe methods to control the accelerated catabolism in order to improve the efficiency of nutritional interventions in patients with ARF.

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“…Since that time, a number of investigations aimed at quantifying prescription and delivery of acute dialysis have been performed (3)(4)(5)(6)(7)(8)(9)(10)(11). Many of these studies have highlighted the need to account for the significant kinetic differences that exist between stable ESRD and critically ill ARF patients (12).…”

Section: Introductionmentioning

confidence: 99%