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Nutritional support in adult critically ill patients with acute kidney injury (AKI): calorie and protein delivery compared to current recommendations

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Razionale

Protein/energy debts developed during ICU stay are associated with increased mortality risk and complication rates. Few data are currently available on this topic in patients with AKI in the Intensive Care Unit (ICU).

Casistica e Metodi

We reviewed the charts of all adult patients staying at least 72 hours at General, Surgical and Renal ICUs (Parma University Hospital) from June 2012 to May 2013, and having a diagnosis of AKI. Daily protein/calorie intakes (calculated, prescribed and actually administered) were obtained up to the first 10 days after AKI diagnosis. Calorie/protein needs were estimated according to the ESPEN 2006-2009 Guidelines. Means and 95% CI from unbalanced data were estimated using mixed regression models for repeated measures.

Risultati

We enrolled 78 patients (22 on RRT): 58 males (74.4%), mean age 65.6 ± 17.0 yrs, SAPS score 56.5 ± 18.4; BMI 27.7 ± 5.6 Kg/m2; enteral nutrition in 69/78 (88.5%), parenteral in 9/78 (11.5%), enteral+parenteral in 46/69 (66.7%), with 725 nutrition-days analyzed. At regimen (5 days from nutritional support start), mean calculated calorie and protein intakes were 1780 Kcal/day and 72 g/day; actual intakes were 1466 Kcal/day (95% CI 1392 to 1542) and 56.5 g/day (95%CI: 52.5 to 60.5), whereas prescribed intakes were 1616 Kcal/day (95%CI 1533 to 1698) and 62.3 g/day (95%CI 57.9 to 66.7)(p < 0.001 for both actual and prescribed vs calculated intakes). At regimen, administered calorie and protein intakes were 82.4% (95%CI: 74.5%  to 92.3%) and 78.3% (95%CI: 74.0% to 82.6%), of calculated amounts; however, cumulative debts at the 7th day of nutritional support were already -12,777 Kcal/patient (95%CI: -13,272  to -12,282) and -509 g/patient (95%CI: -553 to  -466).

Conclusioni

Critically ill patients with AKI are at high risk for developing relevant protein/energy debts, especially in the first days of nutritional support. Both underprescription and underdelivery of nutrients play a major role.

Sabatino A*, Regolisti G*, Cabassi A*, Trenti E*, Picetti E^, Barbagallo M#, Morabito S°, Maggiore U*, Fiaccadori E*
(Renal Failure Unit*, General ICU^, Surgical ICU#, Parma University Hospital, Parma; Nephrology Unit°, “Sapienza” University, Rome, Italy)
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