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Optimal Energy Delivery, Rather than the Implementation of a Feeding Protocol, May Benefit Clinical Outcomes in Critically Ill Patients
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Nutrients 2017, 9(8), 802; doi:10.3390/nu9080802

Energy and Protein in Critically Ill Patients with AKI: A Prospective, Multicenter Observational Study Using Indirect Calorimetry and Protein Catabolic Rate

1
Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine Renal ICU, Parma University Hospital, Parma 43126, Italy
2
Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv 49100, Israel
3
Kidney-Pancreas Transplant Unit, Parma University Hospital, Parma 43126, Italy
4
Surgical ICU, Anesthesia, Intensive Care and Pain Therapy, Parma University Hospital, Parma 43126, Italy
*
Author to whom correspondence should be addressed.
Received: 12 June 2017 / Revised: 13 July 2017 / Accepted: 21 July 2017 / Published: 26 July 2017
(This article belongs to the Special Issue Nutritional Approach to Critically Ill Patients)
View Full-Text   |   Download PDF [758 KB, uploaded 26 July 2017]   |  

Abstract

The optimal nutritional support in Acute Kidney Injury (AKI) still remains an open issue. The present study was aimed at evaluating the validity of conventional predictive formulas for the calculation of both energy expenditure and protein needs in critically ill patients with AKI. A prospective, multicenter, observational study was conducted on adult patients hospitalized with AKI in three different intensive care units (ICU). Nutrient needs were estimated by different methods: the Guidelines of the European Society of Parenteral and Enteral Nutrition (ESPEN) for both calories and proteins, the Harris-Benedict equation, the Penn-State and Faisy-Fagon equations for energy. Actual energy and protein needs were repeatedly measured by indirect calorimetry (IC) and protein catabolic rate (PCR) until oral nutrition start, hospital discharge or renal function recovery. Forty-two patients with AKI were enrolled, with 130 IC and 123 PCR measurements obtained over 654 days of artificial nutrition. No predictive formula was precise enough, and Bland-Altman plots wide limits of agreement for all equations highlight the potential to under- or overfeed individual patients. Conventional predictive formulas may frequently lead to incorrect energy and protein need estimation. In critically ill patients with AKI an increased risk for under- or overfeeding is likely when nutrient needs are estimated instead of measured. View Full-Text
Keywords: acute kidney injury; artificial nutrition; indirect calorimetry; overfeeding; protein catabolic rate; underfeeding acute kidney injury; artificial nutrition; indirect calorimetry; overfeeding; protein catabolic rate; underfeeding
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MDPI and ACS Style

Sabatino, A.; Theilla, M.; Hellerman, M.; Singer, P.; Maggiore, U.; Barbagallo, M.; Regolisti, G.; Fiaccadori, E. Energy and Protein in Critically Ill Patients with AKI: A Prospective, Multicenter Observational Study Using Indirect Calorimetry and Protein Catabolic Rate. Nutrients 2017, 9, 802.

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