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Nutritional and metabolic alterations during continuous renal replacement therapy
Patrick M Honoré1, Elisabeth De Waele, Rita Jacobs
1Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Patrick.Honore@uzbrussel.be
Blood Purification
|May 22, 2013
Summary
Providing adequate nutrition for critically ill patients on continuous renal replacement therapy (CRRT) is complex. Guidelines suggest specific energy, macronutrient, and micronutrient targets, with indirect calorimetry recommended for precise calorie matching.
Area of Science:
- Critical Care Medicine
- Nephrology
- Nutritional Science
Background:
- Adequate nutrition is crucial for critically ill patients.
- Continuous renal replacement therapy (CRRT) presents unique nutritional challenges.
- Existing literature provides limited, yet evolving, guidance on CRRT nutrition.
Purpose of the Study:
- To systematically review and synthesize current literature on nutritional support for critically ill patients undergoing CRRT.
- To establish evidence-based recommendations for energy, macronutrient, and micronutrient intake.
- To identify gaps in knowledge and future research directions.
Main Methods:
- Systematic literature search (1992-2012) adhering to Quorum guidelines.
- Analysis of studies focusing on nutrition in intensive care unit patients treated with CRRT.
- Synthesis of data on recommended energy, carbohydrate, lipid, and protein intake.
Main Results:
- Recommended daily energy intake: 25-35 kcal/kg.
- Macronutrient distribution: 60-70% carbohydrates, 30-40% lipids.
- Protein requirements: 1.5-1.8 g/kg daily.
- Electrolyte balance is generally manageable during CRRT.
- Consensus supports supplementation of glutamine, water-soluble vitamins, and trace elements.
Conclusions:
- Optimizing nutrition in CRRT patients requires careful consideration of energy and macronutrient needs.
- While electrolyte balance is controllable, micronutrient supplementation is advised.
- Development of advanced indirect calorimetry tools is needed for accurate energy assessment in CRRT.
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