Nutritional Status Plays a Crucial Role in the Mortality of Critically Ill Patients with Acute Renal Failure

Abstract

We aimed to clarify associations between nutritional status and mortality in patients with acute renal failure. De-identified data were obtained from the Medical Information Mart for Intensive Care III database comprising more than 40,000 critical care patients treated at Beth Israel Deaconess Medical Centerbetween 2001 and 2012. Weight loss and body mass index criteria were used to define malnutrition. Data of 193 critically ill patients with acute renal failure were analyzed, including demographics, nutrition intervention, laboratory results, and disease severity. Main outcomes were in-hospital and 1-year mortality. The 1-year mortality was significantly higher in those with malnutrition than in those without malnutrition (50.0% vs 29.3%, p=0.010), but differences in in-hospital survival were not significant (p=0.255). Significant differences in mortality were found between those with malnutrition and without starting at the 52nd day after intensive care unit (ICU) discharge (p=0.036). No significant differences were found between men and women with malnutrition in in-hospital mortality (p=0.949) and 1-year mortality (p=0.051). Male patients requiring intervention with blood products/colloid supplements had greater risk of 1-year mortality, but without statistical significance. Nutritional status is a predictive factor for mortality among critically ill patients with acute renal failure, particularly 1-year mortality after ICU discharge.

Nutrition support for acute kidney injury 2020-consensus of the Taiwan AKI task force

“…13 Nevertheless, patients with a BMI of ≥31 kg/m 2 had higher mortality, which was the same as those patients with a low BW (BMI <18 kg/m 2 ). 15,16 For the elderly (aged more than 65 years), a multicenter retrospective analysis that included 2015 patients with AKI which occurred in ICUs after major surgery revealed that patients with a BMI of 21–31 kg/m 2 had lower in-hospital mortality. 15 Results of the forest plot demonstrated that AKI patients who have a lower BMI levels (<18.5 kg/m 2 ) have a higher mortality risk than those with higher BMI (≥18.5 kg/m2) (Fig.…”

“…There was a U-shaped association of BMI with hospital mortality in elderly AKI patients. Zhang et al 16 Retrospective study. 193 critically ill patients with acute renal failure were included.…”

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

“…Studies have demonstrated that 24%-60% of all hospitalized patients with AKI are malnourished and that ∼40% of patients are severely malnourished, as defined by the Subjective Global Assessment (SGA). [15][16][17][18] Similarly, depending on the clinical parameters used to define malnutrition, a prevalence of 31%-50% has been observed in both maintenance HD and peritoneal dialysis patients, of which 6%-8% of patients are severely malnourished. 19,20 There is evidence to suggest that malnutrition is prevalent even before initiation of RRT.…”

Acute Kidney Injury Masked by Malnutrition: A Case Report and the Problem of Protein

“…Nutrition status can also affect clinical outcomes in AKI; observational studies have shown that malnutrition is associated with increased morbidity and mortality among patients with AKI and that deficits in nutrition intakes can negatively affect renal recovery. [15][16][17] Because the kidneys normally maintain acid-base, electrolyte, and fluid balance; perform gluconeogenesis; secrete erythropoietin; and activate vitamin D, the impairment of renal function requires adjustment in the provision of various macronutrients and micronutrients. 18 Additionally, the need for adequate protein administration in the setting of a catabolic condition must be weighed against the risk of azotemia in patients with AKI who have not yet started RRT.…”

“…As a catabolic and proinflammatory condition, AKI affects metabolism and can significantly alter nutrition status. Nutrition status can also affect clinical outcomes in AKI; observational studies have shown that malnutrition is associated with increased morbidity and mortality among patients with AKI and that deficits in nutrition intakes can negatively affect renal recovery . Because the kidneys normally maintain acid‐base, electrolyte, and fluid balance; perform gluconeogenesis; secrete erythropoietin; and activate vitamin D, the impairment of renal function requires adjustment in the provision of various macronutrients and micronutrients .…”