Practical implications of nutritional support during continuous renal replacement therapy

Marin, Angela; Hardy, Gil

doi:10.1097/00075197-200105000-00009

Cited by 36 publications

(48 citation statements)

References 28 publications

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“…Others studies agree with our results that suggest the hypermetabolism may be present in AKI patients since AKI is a part of a more complex illness such as sepsis and not necessarily the direct consequence of renal failure per se suggesting that AKI does not influence the energy metabolism of septic patients [16][17][18][19][20][21].…”

Section: Discussionsupporting

confidence: 91%

“…In contrast, a hypermetabolic state was frequently observed in AKI patients and associated with its cause and severity [15]. The hypermetabolism may be present in AKI patients since AKI is a part of a more complex illness such as sepsis and not necessarily the direct consequence of renal failure per se [15][16][17][18][19][20][21]. Thus, it is unknown whether possible changes in energy metabolism observed in septic AKI patients are directly related to AKI itself.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of energy metabolism in septic patients with and without AKI

Sanches

Góes

Bufarah

et al. 2017

Nutrire

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Background: The determination of resting energy expenditure (REE) in critically ill patients could prevent complications such as hypo-and hyperalimentation. This study aims to describe the REE in septic patients with and without acute kidney injury (AKI) and compare the REE estimated by the Harris-Benedict equation (HB) with the REE measured by indirect calorimetry (IC). Methods: Prospective and observational study was performed. Septic patients older than 18 years, undergoing mechanical ventilation, with or without AKI defined by KDIGO criteria, and admitted to the Intensive Care Unit of University Hospital from Brazil were included. The REE was estimated by HB equation and measured by the IC within 72 h after the diagnosis of sepsis and 7 days after the initial measure. Results: Sixty-eight patients were evaluated, age was 62.5 ± 16.6 years, 64.7% were male, 63.2% had AKI, and SOFA was 9.8 ± 2.35. The measured REE was 1857.5 ± 685.32 kcal, while the estimated REE was 1514.8 ± 356.72 kcal, with adequacy of 123.5 ± 43%. Septic patients without AKI (n = 25) and with AKI (n = 43) had measured REE statistically higher than the estimated one Conclusions: The REE measured by IC was significantly higher than that estimated by HB equation in both septic with and without AKI. There was no significant difference in REE between the septic patients with and without AKI, suggesting that AKI does not influence the energy metabolism of septic patients.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Evaluation of energy metabolism in septic patients with and without AKI

Sanches

Góes

Bufarah

et al. 2017

Nutrire

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“…"Nitrojen dengesi" ölçümünün sağlıklı sonuç verebilmesi için kreatinin klirensinin > 50 ml/dak/1,73 m 2 olması gerekir, bu durum nitrojen dengesinin ABH'lı hastalarda kullanımını güçleştirir. ABH'lı hastalarda UNA ölçümü daha az zahmetlidir ve daha kesin sonuç verebilir, (25,26), ayrıca asidoz varlığında lipoprotein lipaz aktivitesi inhibe olmaktadır (27).…”

Section: Akut Böbrek Hasarında Oluşan Metabolik Değişikliklerunclassified

Nutritional Support in Acute Kidney Injury

Bilgic¹,

Akçay²,

Sezer³

2013

turk Neph Dial Transpl

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ÖZAkut böbrek hasarı (ABH), hastanede yatan hastalarda oldukça sık karşılaşılan bir komplikasyondur ve morbidite ve mortalitede artış ile ilişkilidir. ABH nadiren izole organ yetmezliği olarak görülür, daha sıklıkla kritik hastalık olarak tanımlanan ciddi ve uzamış katabolik faz ile karakterize çoklu organ yetmezliği sendromunun bir parçası olarak ortaya çıkar. ABH'lı hastalar sıklıkla protein-enerji tüketimi içindedir ki bu önemli bir olumsuz prognostik faktördür. Akut böbrek hasarlı hastalarda malnütrisyon, komplikasyon gelişme riski, hospitalizasyon süresi ve hastane mortalitesinde artış ile ilişkilidir. Bu nedenle ABH'lı hastaların tedavisinde uygun beslenme desteğinin yer alması elzemdir. Beslenme gereksinimi değerlendirilirken hastanın altta yatan hastalığı, komorbid durumları ve böbrek fonksiyon bozukluğunun ciddiyeti ile renal replasman tedavisi (RRT) ihtiyacı dikkate alınmalıdır. ABH'da beslenme desteğinin esas amacı, normal böbrek fonksiyonuna sahip kritik hastalar için önerilene benzerdir: yeterli miktarda besin öğesi sağlandığından emin olmak, metabolik komplikasyonlara eşlik eden protein-enerji tüketimini önlemek ve mortaliteyi azaltmak. ABH, aynı hastanın bile klinik takip süresince büyük ölçüde değişen beslenme ihtiyacına sahip olduğu oldukça heterojen bir hasta grubunu kapsadığından beslenme gereksinimi açısından değerlendirme aralıklı olarak tekrar edilmeli, bireyselleştirilmeli ve RRT ile bütünleştirilmelidir.. AnAhtAR SÖZcüKLER: Akut böbrek hasarı, Beslenme değerlendirmesi, Beslenme tedavisi ABStRActAcute kidney injury (AKI) is a frequent complication affecting many hospitalized patients and is associated with increased morbidity and mortality. AKI seldom occurs as isolated organ failure; much more often it emerges as a component of the multiple organ failure syndrome, within the framework of the severe-prolonged catabolic phase determined by critical illness. Patients with AKI often have protein-energy wasting, which represents a major negative prognostic factor. Malnutrition in AKI patients is associated with increased risk of complications, longer hospitalization, and higher hospital mortality. Hence, appropriate nutritional support is essential in the management of the AKI patient. Assessment of nutritional requirements should take into account the patient's underlying disease, comorbid medical conditions, severity of the renal dysfunction and need for RRT. The primary goals of nutritional support in AKI are the same as those suggested for critically ill patients with normal renal function: to ensure the delivery of adequate amounts of nutrients, to prevent protein-energy wasting with the attendant metabolic complications, to reduce mortality. Since AKI comprises a highly heterogeneous group of subjects with nutrient needs widely varying even along the clinical course in the same patient, nutritional requirements should be frequently reassessed, individualized and carefully integrated with RRT..

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“…1 The nutritional implications of CRRT are significant and vary with the type and intensity of each modality. 10 …”

Section: Specialized Nutrition Support In Patients Treated With Crrtmentioning

confidence: 99%

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

2005

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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.

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Practical implications of nutritional support during continuous renal replacement therapy

Cited by 36 publications

References 28 publications

Evaluation of energy metabolism in septic patients with and without AKI

Evaluation of energy metabolism in septic patients with and without AKI

Nutritional Support in Acute Kidney Injury

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

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