Nutrition in acute renal failure

Nutrition is an integral part of supportive therapy of acute renal failure. Since ARF usually develops as a consequence of severe illness or injury, the metabolic changes due to failing kidney function are superimposed, often indistinguishably, on the metabolic effects of the primary disease. The majority of patients are hypercatabolic and may therefore become rapidly nutritionally depleted. The general principles of treatment are early dialysis, strict monitoring of vital functions, vigorous treatment of observed disorders, and metabolic monitoring and therapy. Use of enteral nutrition is rarely feasible and hence nutrition is given as TPN. The volume of fluid is not limiting for the application of TPN if adequate dialysis or continuous filtration methods are available. The TPN program of an average adult should contain daily approximately 35 to 40 kcal/kg of energy, given as both fat and glucose, and 1 g/kg of amino acids, given as both essential and nonessential amino acids, though the true requirements in ARF are unknown. The actual intakes of nutrients may have to be frequently adjusted according to the response of the patient.