Nutritional aspects in patients with acute renal failure/multiorgan failure

Nutrition support contributes to reducing morbidity and mortality in patients with the multiple-organ dysfunction syndrome (MODS). In cases when acute renal failure is a component of MODS, the goals of nutritional management should be to control general nutrient deficiencies and correct specific metabolic alterations caused by the loss of renal function or acute uraemia without worsening uraemic toxicity or disturbing electrolyte balance. In most cases energy requirements, which should ideally be estimated by indirect calorimetric measurements, amount to 30 kcal/kg/day and only seldom exceed 35 kcal/kg/day. Depending on the degree of protein catabolism, 1.0-1.5 g/kg/day of protein should be given. A balanced amino acid solution containing both essential and nonessential amino acids should be administered. Uraemia impairs protein synthesis and nitrogen administration should, therefore, not be started until the uraemic state is adequately controlled by dialysis or haemofiltration.