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Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
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Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in...
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Nutritional assessment and support during continuous renal replacement therapy.

Marlies Ostermann1, Nuttha Lumlertgul1,2,3, Ravindra Mehta4

  • 1Department of Critical Care, Guy's & St Thomas' Hospital, London, UK.

Seminars in Dialysis
|April 28, 2021
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Summary

Malnutrition is common in acute kidney injury patients on renal replacement therapy (RRT). Optimal nutrition requires careful energy and protein assessment, but specific targets for RRT patients remain unclear, necessitating further research.

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Area of Science:

  • Nephrology
  • Clinical Nutrition
  • Critical Care Medicine

Background:

  • Malnutrition is prevalent in acute kidney injury (AKI) patients, particularly those undergoing renal replacement therapy (RRT).
  • Accurate nutritional assessment in RRT patients is complex, requiring a multimodal approach beyond single diagnostic tests.
  • Existing guidelines lack specific nutritional targets for RRT populations, leading to potential under- or overfeeding.

Purpose of the Study:

  • To review current knowledge on nutritional management in patients receiving continuous renal replacement therapy (CRRT).
  • To identify uncertainties and knowledge gaps regarding nutritional therapy in CRRT patients.
  • To highlight the need for further research into optimal nutritional strategies for this vulnerable patient group.

Main Methods:

  • Literature review of existing studies on nutrition in AKI and RRT.
  • Analysis of nutritional challenges associated with CRRT, including nutrient losses and gains.
  • Synthesis of data on energy expenditure, nitrogen balance, and protein requirements.

Main Results:

  • Indirect calorimetry or predictive equations are recommended for energy expenditure assessment in RRT patients.
  • Periodic nitrogen balance measurement is crucial for monitoring catabolism and protein intake.
  • Nutrient losses in CRRT effluent and caloric contributions from solutions complicate nutritional management.

Conclusions:

  • Specific nutritional targets, especially protein intake, are poorly defined for CRRT patients.
  • The role and efficacy of micronutrient supplementation and enriched CRRT solutions require investigation.
  • More research is essential to establish evidence-based nutritional guidelines for patients on CRRT.