Impact of continuous renal replacement therapy on nutritional support in critically ill patients_West China Medical Journal

Authors：

 DAI Xiaoyu , ZHANG Xingyu , FENG Qian

Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

DAI Xiaoyu, Email: daixy001@163.com

Keywords：

Continuous renal replacement therapy; Nutritional support; Critically ill patients

DOI：

10.7507/1002-0179.202004290

Video：

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Continuous renal replacement therapy (CRRT) is the treatment of choice for critically ill patients with hemodynamic instability who require renal replacement therapy. This review summarizes the impact of CRRT treatment on nutritional support in critically ill patients, including: energy increase caused by citrate-based anticoagulants, energy loss caused by glucose-free replacement fluid and dialysate, a large amount of amino acids loss in the effluent, and the influences on the way of lipid emulsion administration, capacity, electrolyte, vitamins, and trace elements. It is hoped that the intensive care unit doctors, nephrologists, and nutritionists can fully cooperate to determine the CRRT prescription and the nutritional support prescription.

Citation： DAI Xiaoyu, ZHANG Xingyu, FENG Qian. Impact of continuous renal replacement therapy on nutritional support in critically ill patients. West China Medical Journal, 2021, 36(7): 964-968. doi: 10.7507/1002-0179.202004290 Copy

1.	Koeze J, Keus F, Dieperink W, et al. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC Nephrol, 2017, 18(1): 70.
2.	Park S, Lee S, Jo HA, et al. Epidemiology of continuous renal replacement therapy in Korea: results from the National Health Insurance Service claims database from 2005 to 2016. Kidney Res Clin Pract, 2018, 37(2): 119-129.
3.	Carrero JJ, Thomas F, Nagy K, et al. Global prevalence of protein-energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the International Society of Renal Nutrition and Metabolism. J Ren Nutr, 2018, 28(6): 380-392.
4.	Ilias I, Vassiliadi DA, Theodorakopoulou M, et al. Adipose tissue lipolysis and circulating lipids in acute and subacute critical illness: effects of shock and treatment. J Crit Care, 2014, 29(6): 1130.e5-1130.e1.13E9.
5.	Kim H, Kim J, Seo C, et al. Body mass index is inversely associated with mortality in patients with acute kidney injury undergoing continuous renal replacement therapy. Kidney Res Clin Pract, 2017, 36(1): 39-47.
6.	Ronco C. Continuous renal replacement therapy: forty-year anniversary. Int J Artif Organs, 2017, 40(6): 257-264.
7.	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-184.
8.	Tian JH, Ma B, Yang K, et al. Bicarbonate- versus lactate-buffered solutions for acute continuous haemodiafiltration or haemofiltration. Cochrane Database Syst Rev, 2015(3): CD006819.
9.	Bellomo R, Cass A, Cole L, et al. Calorie intake and patient outcomes in severe acute kidney injury: findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial. Crit Care, 2014, 18(2): R45.
10.	Mundi MS, Nystrom EM, Hurley DL, et al. Management of parenteral nutrition in hospitalized adult patients. JPEN J Parenter Enteral Nutr, 2017, 41(4): 535-549.
11.	Wolfe RR. The 2017 Sir David P Cuthbertson lecture. Amino acids and muscle protein metabolism in critical care. Clin Nutr, 2018, 37(4): 1093-1100.
12.	New AM, Nystrom EM, Frazee E, et al. Continuous renal replacement therapy: a potential source of calories in the critically ill. Am J Clin Nutr, 2017, 105(6): 1559-1563.
13.	Nystrom EM, Nei AM. Metabolic support of the patient on continuous renal replacement therapy. Nutr Clin Pract, 2018, 33(6): 754-766.
14.	Balik M, Zakharchenko M, Otahal M, et al. Quantification of systemic delivery of substrates for intermediate metabolism during citrate anticoagulation of continuous renal replacement therapy. Blood Purif, 2012, 33(1/2/3): 80-87.
15.	Zappitelli M, Juarez M, Castillo L, et al. Continuous renal replacement therapy amino acid, trace metal and folate clearance in critically ill children. Intensive Care Med, 2009, 35(4): 698-706.
16.	Wu B, Ji D, Xu B, et al. New modes of continuous renal replacement therapy using a refiltering technique to reduce micronutrient loss. Hemodial Int, 2019, 23(2): 181-188.
17.	Hurt RT, McClave SA, Martindale RG, et al. Summary points and consensus recommendations from the international protein summit. Nutr Clin Pract, 2017, 32(1_suppl): 142s-151s.
18.	McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
19.	McLaughlin DC, Fang DC, Nolot BA, et al. Hypertriglyceridemia causing continuous renal replacement therapy dysfunction in a patient with end-stage liver disease. Indian J Nephrol, 2018, 28(4): 303-306.
20.	Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol, 2014, 48(3): 195-203.
21.	Kazory A, Clapp WL, Ejaz AA, et al. Shortened hemofilter survival time due to lipid infusion in continuous renal replacement therapy. Nephron Clin Pract, 2008, 108(1): c5-c9.
22.	Kreymann KG, Berger MM, Deutz NE, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr, 2006, 25(2): 210-223.
23.	Heung M, Mueller BA. Prevention of hypophosphatemia during continuous renal replacement therapy. An overlooked problem. Semin Dial, 2018, 31(3): 213-218.
24.	Schmitz M, Joannidis M, Czock D, et al. Regional citrate anticoagulation in renal replacement therapy in the intensive care station: recommendations from the renal section of the DGIIN, ÖGIAIN and DIVI. Med Klin Intensivmed Notfmed, 2018, 113(5): 377-383.
25.	Schneider AG, Picard W, Honoré PM, et al. Amino acids and vitamins status during continuous renal replacement therapy: an ancillary prospective observational study of a randomised control trial. Anaesth Crit Care Pain Med, 2021, 40(2): 100813.
26.	Ben-Hamouda N, Charrière M, Voirol P, et al. Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement. Nutrition, 2017, 34(34): 71-75.
27.	Cano NJ, Aparicio M, Brunori G, et al. ESPEN guidelines on parenteral nutrition: adult renal failure. Clin Nutr, 2009, 28(4): 401-414.

1. Koeze J, Keus F, Dieperink W, et al. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC Nephrol, 2017, 18(1): 70.
2. Park S, Lee S, Jo HA, et al. Epidemiology of continuous renal replacement therapy in Korea: results from the National Health Insurance Service claims database from 2005 to 2016. Kidney Res Clin Pract, 2018, 37(2): 119-129.
3. Carrero JJ, Thomas F, Nagy K, et al. Global prevalence of protein-energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the International Society of Renal Nutrition and Metabolism. J Ren Nutr, 2018, 28(6): 380-392.
4. Ilias I, Vassiliadi DA, Theodorakopoulou M, et al. Adipose tissue lipolysis and circulating lipids in acute and subacute critical illness: effects of shock and treatment. J Crit Care, 2014, 29(6): 1130.e5-1130.e1.13E9.
5. Kim H, Kim J, Seo C, et al. Body mass index is inversely associated with mortality in patients with acute kidney injury undergoing continuous renal replacement therapy. Kidney Res Clin Pract, 2017, 36(1): 39-47.
6. Ronco C. Continuous renal replacement therapy: forty-year anniversary. Int J Artif Organs, 2017, 40(6): 257-264.
7. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-184.
8. Tian JH, Ma B, Yang K, et al. Bicarbonate- versus lactate-buffered solutions for acute continuous haemodiafiltration or haemofiltration. Cochrane Database Syst Rev, 2015(3): CD006819.
9. Bellomo R, Cass A, Cole L, et al. Calorie intake and patient outcomes in severe acute kidney injury: findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial. Crit Care, 2014, 18(2): R45.
10. Mundi MS, Nystrom EM, Hurley DL, et al. Management of parenteral nutrition in hospitalized adult patients. JPEN J Parenter Enteral Nutr, 2017, 41(4): 535-549.
11. Wolfe RR. The 2017 Sir David P Cuthbertson lecture. Amino acids and muscle protein metabolism in critical care. Clin Nutr, 2018, 37(4): 1093-1100.
12. New AM, Nystrom EM, Frazee E, et al. Continuous renal replacement therapy: a potential source of calories in the critically ill. Am J Clin Nutr, 2017, 105(6): 1559-1563.
13. Nystrom EM, Nei AM. Metabolic support of the patient on continuous renal replacement therapy. Nutr Clin Pract, 2018, 33(6): 754-766.
14. Balik M, Zakharchenko M, Otahal M, et al. Quantification of systemic delivery of substrates for intermediate metabolism during citrate anticoagulation of continuous renal replacement therapy. Blood Purif, 2012, 33(1/2/3): 80-87.
15. Zappitelli M, Juarez M, Castillo L, et al. Continuous renal replacement therapy amino acid, trace metal and folate clearance in critically ill children. Intensive Care Med, 2009, 35(4): 698-706.
16. Wu B, Ji D, Xu B, et al. New modes of continuous renal replacement therapy using a refiltering technique to reduce micronutrient loss. Hemodial Int, 2019, 23(2): 181-188.
17. Hurt RT, McClave SA, Martindale RG, et al. Summary points and consensus recommendations from the international protein summit. Nutr Clin Pract, 2017, 32(1_suppl): 142s-151s.
18. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
19. McLaughlin DC, Fang DC, Nolot BA, et al. Hypertriglyceridemia causing continuous renal replacement therapy dysfunction in a patient with end-stage liver disease. Indian J Nephrol, 2018, 28(4): 303-306.
20. Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol, 2014, 48(3): 195-203.
21. Kazory A, Clapp WL, Ejaz AA, et al. Shortened hemofilter survival time due to lipid infusion in continuous renal replacement therapy. Nephron Clin Pract, 2008, 108(1): c5-c9.
22. Kreymann KG, Berger MM, Deutz NE, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr, 2006, 25(2): 210-223.
23. Heung M, Mueller BA. Prevention of hypophosphatemia during continuous renal replacement therapy. An overlooked problem. Semin Dial, 2018, 31(3): 213-218.
24. Schmitz M, Joannidis M, Czock D, et al. Regional citrate anticoagulation in renal replacement therapy in the intensive care station: recommendations from the renal section of the DGIIN, ÖGIAIN and DIVI. Med Klin Intensivmed Notfmed, 2018, 113(5): 377-383.
25. Schneider AG, Picard W, Honoré PM, et al. Amino acids and vitamins status during continuous renal replacement therapy: an ancillary prospective observational study of a randomised control trial. Anaesth Crit Care Pain Med, 2021, 40(2): 100813.
26. Ben-Hamouda N, Charrière M, Voirol P, et al. Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement. Nutrition, 2017, 34(34): 71-75.
27. Cano NJ, Aparicio M, Brunori G, et al. ESPEN guidelines on parenteral nutrition: adult renal failure. Clin Nutr, 2009, 28(4): 401-414.

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