McCarthy Mary S, Phipps Shauna C
Mary S. McCarthy, RN, Center for Nursing Science & Clinical Inquiry, Madigan Army Medical Center, MCHJ-CNI 1-57-7, 9040A Jackson Ave, Tacoma, WA 98431, USA. Email:
Nutr Clin Pract. 2014 Feb;29(1):56-62. doi: 10.1177/0884533613515726. Epub 2013 Dec 16.
Acute kidney injury (AKI), previously known as acute renal failure, is defined as a sudden decline in glomerular filtration rate with accumulation of metabolic waste products, toxins, and drugs, as well as alteration in the intrinsic functions of the kidney. Reports of mortality are as high as 80%, with numerous contributing causes including infection, cardiorespiratory complications, and cardiovascular disease. Concurrent with the high prevalence of critical illness in this population is the protein energy wasting (PEW), seen in up to 42% of patients upon intensive care unit admission. The pathophysiologic derangements of critical illness, the low energy and protein stores, and uremic complications require early nutrition intervention to attenuate the inflammatory response and oxidative stress, improve endothelial function, stabilize blood sugar, and preserve lean body mass. This article addresses the unique challenges of nutrition support for the patient with AKI in the setting of critical illness and renal replacement therapy. Evidence-based recommendations are provided to meet the macronutrient and micronutrient requirements of this heterogeneous and complex patient population.
急性肾损伤（AKI），以前称为急性肾衰竭，定义为肾小球滤过率突然下降，伴有代谢废物、毒素和药物的蓄积，以及肾脏固有功能的改变。死亡率报告高达80%，其成因众多，包括感染、心肺并发症和心血管疾病。在这一人群中，危重病的高患病率与蛋白质能量消耗（PEW）并存，在重症监护病房入院时，高达42%的患者出现这种情况。危重病的病理生理紊乱、低能量和蛋白质储备以及尿毒症并发症需要早期营养干预，以减轻炎症反应和氧化应激，改善内皮功能，稳定血糖，并维持瘦体重。本文探讨了在危重病和肾脏替代治疗背景下，为急性肾损伤患者提供营养支持所面临的独特挑战。提供基于证据的建议，以满足这一异质性和复杂患者群体的宏量营养素和微量营养素需求。
