Nutrition support therapy in acute kidney injury: Distinguishing dogma from good practice

Gervasio, Jane M.; Cotton, Ann

doi:10.1007/s11894-009-0047-x

Cited by 8 publications

(6 citation statements)

References 41 publications

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“…The current therapeutic approach for patients with acute catabolic conditions, such as those with acute kidney injury (81)(82)(83)(84), consists mainly of enteral or parenteral nutrition, which are designed to increase protein and energy intakes. These techniques, on the other hand, have been less well studied in patients with PEW and NDD CKD, in whom the optimal amount of daily protein intake under these circumstances remains unclear.…”

mentioning

confidence: 99%

Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy

Kövesdy

Kopple²,

Kalantar-Zadeh³

2013

The American Journal of Clinical Nutrition

236

194

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Protein-energy wasting (PEW), characterized by a decline in body protein mass and energy reserves, including muscle and fat wasting and visceral protein pool contraction, is an underappreciated condition in early to moderate stages of chronic kidney disease (CKD) and a strong predictor of adverse outcomes. The prevalence of PEW in early to moderate CKD is $20-25% and increases as CKD progresses, in part because of activation of proinflammatory cytokines combined with superimposed hypercatabolic states and declines in appetite. This anorexia leads to inadequate protein and energy intake, which may be reinforced by prescribed dietary restrictions and inadequate monitoring of the patient's nutritional status. Worsening uremia also renders CKD patients vulnerable to potentially deleterious effects of uncontrolled diets, including higher phosphorus and potassium burden. Uremic metabolites, some of which are anorexigenic and many of which are products of protein metabolism, can exert harmful effects, ranging from oxidative stress to endothelial dysfunction, nitric oxide disarrays, renal interstitial fibrosis, sarcopenia, and worsening proteinuria and kidney function. Given such complex pathways, nutritional interventions in CKD, when applied in concert with nonnutritional therapeutic approaches, encompass an array of strategies (such as dietary restrictions and supplementations) aimed at optimizing both patients' biochemical variables and their clinical outcomes. The applicability of many nutritional interventions and their effects on outcomes in patients with CKD with PEW has not been well studied. This article reviews the definitions and pathophysiology of PEW in patients with non-dialysis-dependent CKD, examines the current indications for various dietary modification strategies in patients with CKD (eg, manufactured protein-based supplements, amino acids and their keto acid or hydroxyacid analogues), discusses the rationale behind their potential use in patients with PEW, and highlights areas in need of further research.

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mentioning

confidence: 99%

Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy

Kövesdy

Kopple²,

Kalantar-Zadeh³

2013

The American Journal of Clinical Nutrition

236

194

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“…66 In patients with AKI, ascertaining the urea nitrogen output is less laborious and may be more accurate; however, protein-intake fluctuation and varying catabolic presentations may result in erroneous calculated results. 69,70 To best assess the nutrition status of patients with AKI, the clinician and dietitian must work together to recognize the innate complications associated with the anthropometric markers, implementing good clinical judgment and including key elements from the patient's history, presentation, and clinical course.…”

Section: Screening and Assessment Of Nutrition Status In Hospitalizedmentioning

confidence: 99%

Acute Kidney Injury Incidence in Hospitalized Patients and Implications for Nutrition Support

et al. 2020

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Hospitalized adult patients suffer from high rates of acute kidney injury (AKI), which puts them at risk for multiple nutrition problems. The etiology and management strategy of AKI has major implications for the management of the hospitalized patient. The purpose of this review is to understand the incidence and management of AKI in hospitalized adult patients and review the challenges to providing adequate nutrition support.

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“…In patients with AKI, ascertaining the UNA is less laborious and may be more accurate; however, protein intake fluctuation and varying catabolic presentations may result in calculated erroneous results. 9 , 25 …”

Section: Nutrient Metabolismmentioning

confidence: 99%

“…Lowering the protein delivery may be necessary to avoid azotemia. However, restricting protein or delivering inadequate amounts of protein is not advised because it increases the patient's risk for protein malnutrition and associated complications 25 . Advanced presentations of AKI in acutely ill patients usually require renal replacement therapy (RRT), including intermittent hemodialysis (IHD) and continuous RRT (CRRT), because of the catabolism associated with the critical illness, metabolic acidosis, and increased insulin resistance.…”

Section: Nutrient Metabolismmentioning

confidence: 99%

Nutrition Support in Acute Kidney Injury

2011

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Acute kidney injury is a frequent complication affecting many hospitalized patients and is associated with increased morbidity and mortality. Acute kidney injury often occurs in conjunction with critical illness, which is a hypermetabolic state presenting with hyperglycemia, insulin resistance, hypertriglyceridemia, and increased protein catabolism. In addition to addressing these changes, the clinician should evaluate the important nutrition implications of decreased kidney function. These include vitamins, electrolytes, minerals, trace elements, and the presence and type of renal replacement therapy. Optimal nutrition management in acute kidney injury includes providing adequate macronutrient support to correct underlying conditions and prevent ongoing loss, supplementing micronutrients and vitamins during renal replacement therapy, and adjusting electrolyte replacement based on the degree and extent of renal dysfunction.

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Nutrition support therapy in acute kidney injury: Distinguishing dogma from good practice

Cited by 8 publications

References 41 publications

Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy

Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy

Acute Kidney Injury Incidence in Hospitalized Patients and Implications for Nutrition Support

Nutrition Support in Acute Kidney Injury

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