Nutritional support in acute kidney injury

Area of Science:

• Nephrology
• Critical Care Medicine
• Clinical Nutrition

Background:

• Acute kidney injury (AKI) rarely occurs in isolation, often presenting as part of multiple organ failure in critically ill patients.
• AKI exacerbates the catabolic state of critical illness, leading to protein-energy wasting, a significant negative prognostic factor.
• Nutritional support is frequently indicated for AKI patients, though its direct impact on major outcomes remains unproven.

Purpose of the Study:

• To outline the primary goals of nutritional support in AKI patients.
• To provide specific nutritional recommendations for AKI patients undergoing renal replacement therapy (RRT).
• To highlight potential complications of nutritional support in AKI and emphasize the need for individualized care.

Main Methods:

• Review of current literature and clinical guidelines regarding nutritional management in AKI.
• Analysis of protein and energy requirements for AKI patients, particularly those on RRT.
• Discussion of preferred routes of nutrient delivery (enteral vs. parenteral) and potential complications.

Main Results:

• Primary goals include adequate nutrient delivery, prevention of protein-energy wasting, and support of healing and immune function.
• For AKI patients on RRT: protein intake ≥1.5 g/kg/day, non-protein calories ≤30 kcal/kg/day or 1.3 x BEE, with lipids at 30-35% of energy.
• AKI patients are prone to hyperglycemia, hypertriglyceridemia, fluid retention, and electrolyte/acid-base imbalances due to impaired kidney function and RRT.

Conclusions:

• Nutritional support aims to optimize outcomes in AKI by addressing protein-energy wasting and metabolic derangements.
• Individualized nutritional strategies, frequently reassessed and integrated with RRT, are critical for managing heterogeneous AKI patient needs.
• Close monitoring for complications is essential due to the altered homeostatic function in AKI patients.