Berbel Marina Nogueira, Pinto Milene Peron Rodrigues, Ponce Daniela, Balbi André Luís
Grupo de Lesão Renal Aguda, Hospital das Clínicas, Faculdade de Medicina de Botucatu, UNESP, Botucatu, SP, Brazil.
Rev Assoc Med Bras (1992). 2011 Sep-Oct;57(5):600-6. doi: 10.1590/s0104-42302011000500022.
Nutritional assessment is an indispensable tool for the evaluation and clinical monitoring of patients with acute kidney injury (AKI). Acute loss of renal function interferes with the metabolism of all macronutrients, responsible for proinflammatory, pro-oxidative and hypercatabolic situations. The major nutritional disorders in AKI patients are hypercatabolism, hyperglycemia, and hypertriglyceridemia. Those added to the contributions of the underlying disease, complications, and the need for renal replacement therapy can interfere in the nutritional depletion of those patients. Malnutrition in AKI patients is associated with increased incidence of complications, longer hospitalization, and higher hospital mortality. However, there are few studies evaluating the nutritional status of AKI patients. Anthropometric parameters, such as body mass index, arm circumference, and thickness of skin folds, are difficult to interpret due to changes in hydration status in those patients. Biochemical parameters commonly used in clinical practice are also influenced by non-nutritional factors like loss of liver function and inflammatory status. Although there are no prospective data about the behavior of nutritional markers, some authors demonstrated associations of some parameters with clinical outcomes. The use of markers like albumin, cholesterol, prealbumin, IGF-1, subjective global assessment, and calculation of the nitrogen balance seem to be useful as screening parameters for worse prognosis and higher mortality in AKI patients. In patients with AKI on renal replacement therapy, a caloric intake of 25 to 30 kcal/kg and a minimum amount of 1.5 g/kg/day of protein is recommended to minimize protein catabolism and prevent metabolic complications.
营养评估是急性肾损伤（AKI）患者评估和临床监测中不可或缺的工具。肾功能的急性丧失会干扰所有常量营养素的代谢，引发促炎、促氧化和高分解代谢状态。AKI患者的主要营养紊乱包括高分解代谢、高血糖和高甘油三酯血症。这些因素加上基础疾病、并发症的影响以及肾脏替代治疗的需求，会干扰这些患者的营养消耗。AKI患者的营养不良与并发症发生率增加、住院时间延长和医院死亡率升高有关。然而，评估AKI患者营养状况的研究较少。由于这些患者的水化状态变化，人体测量参数，如体重指数、臂围和皮褶厚度，难以解读。临床实践中常用的生化参数也受到肝功能丧失和炎症状态等非营养因素的影响。尽管目前尚无关于营养标志物变化的前瞻性数据，但一些作者表明某些参数与临床结局有关。使用白蛋白、胆固醇、前白蛋白、胰岛素样生长因子-1、主观全面评定以及氮平衡计算等标志物，似乎有助于作为AKI患者预后较差和死亡率较高的筛查参数。对于接受肾脏替代治疗的AKI患者，建议热量摄入为25至30千卡/千克，蛋白质摄入量至少为1.5克/千克/天，以尽量减少蛋白质分解代谢并预防代谢并发症。
