Is parenteral nutrition therapy of value in acute renal failure patients?

A patient with oliguric acute renal failure (ARF) following mitral valve surgery is presented. The patient was treated with parenteral nutrition and hemodialysis. While the patient survived, there were several complications of nutrition therapy. In this review, the benefits, risks, and uncertainties regarding parenteral nutrition in ARF are considered. First, the differences in metabolism in complicated and uncomplicated acute uremia are discussed. The important roles of alterations in intermediary metabolism and of proteases in the catabolism of ARF are emphasized. The historical basis of parenteral nutrition treatment in ARF is reviewed. The results are divided regarding the relationship among nutritional support, improvement in renal function, and enhanced patient survival. A critical analysis of nitrogen metabolism results reported in the literature does not convincingly support the effectiveness of parenteral nutrition formulae in generating positive nitrogen balance. The complications of parenteral nutrition therapy are outlined. In light of the uncertain efficacy and recognized risks of prolonged parenteral nutrition, a rationale for approaching therapy is presented that is based on the estimated metabolic stress and protein-energy requirements of the individual ARF patient.