Btaiche Imad F, Mohammad Rima A, Alaniz Cesar, Mueller Bruce A
Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan, USA.
Pharmacotherapy. 2008 May;28(5):600-13. doi: 10.1592/phco.28.5.600.
Acute kidney injury in critically ill patients is often a complication of an underlying condition such as organ failure, sepsis, or drug therapy. In these patients, stress-induced hypercatabolism results in loss of body cell mass. Unless nutrition support is provided, malnutrition and negative nitrogen balance may ensue. Because of metabolic, fluid, and electrolyte abnormalities, optimization of nutrition to patients with acute kidney injury presents a challenge to the clinician. In patients treated with conventional intermittent hemodialysis, achieving adequate amino acid intake can be limited by azotemia and fluid restriction. With the use of continuous renal replacement therapy (CRRT), however, better control of azotemia and liberalization of fluid intake allow amino acid intake to be maximized to support the patient's metabolic needs. High amino acid doses up to 2.5 g/kg/day in patients treated with CRRT improved nitrogen balance. However, to our knowledge, no studies have correlated increased amino acid intake with improved outcomes in critically ill patients with acute kidney injury. Data from large, prospective, randomized, controlled trials are needed to optimize the dosing of amino acids in critically ill patients with acute kidney injury who are treated with CRRT and to study the safety of high doses and their effects on patient morbidity and survival.
危重症患者的急性肾损伤通常是诸如器官衰竭、脓毒症或药物治疗等基础疾病的并发症。在这些患者中，应激诱导的高分解代谢导致身体细胞质量的丧失。除非提供营养支持，否则可能会出现营养不良和负氮平衡。由于代谢、液体和电解质异常，对急性肾损伤患者进行营养优化对临床医生来说是一项挑战。在接受传统间歇性血液透析治疗的患者中，氮质血症和液体限制可能会限制氨基酸的充分摄入。然而，使用连续性肾脏替代治疗（CRRT）时，对氮质血症的更好控制和液体摄入的放宽使得氨基酸摄入量能够最大化，以满足患者的代谢需求。接受CRRT治疗的患者使用高达2.5 g/kg/天的高剂量氨基酸可改善氮平衡。然而，据我们所知，尚无研究将急性肾损伤危重症患者氨基酸摄入量的增加与改善的预后相关联。需要来自大型、前瞻性、随机、对照试验的数据，以优化接受CRRT治疗的急性肾损伤危重症患者的氨基酸剂量，并研究高剂量的安全性及其对患者发病率和生存率的影响。
