Nutritional support in acute renal failure.

Abstract

PURPOSE OF REVIEW: Acute renal failure is commonly present in patients with sepsis, shock, trauma, burn injury, or multi-organ dysfunction syndrome. Acute renal failure is an independent risk factor contributing to increased hospital mortality. The major complications associated with acute renal failure include metabolic derangement and protein catabolism. The purpose of this article is to review the literature between 2001 and December 2003, to determine whether newer studies have provided a better understanding of the optimization of caloric and protein delivery to critically ill patients with acute renal failure receiving continuous renal replacement therapy. RECENT FINDINGS: Continuous renal replacement therapy is now widely used in the intensive care unit to manage patients with acute renal failure, because it is better tolerated than intermittent hemodialysis by patients who are hemodynamically unstable. Although continuous renal replacement therapy is highly efficient in the removal of toxins and metabolic wastes, it may also lead to an excessive loss of nutrients, which include intact protein and amino acids. Data describing the optimal nutritional support regimen for patients receiving continuous renal replacement therapy are very limited. SUMMARY: The results and findings from this review may help clinicians to individualize caloric and protein delivery for patients with acute renal failure. The ultimate goal is to tailor the regimen towards the needs of each individual patient in order to maximize the benefit of nutritional support, in the hope of improving patient survival.