Oh Weng C, Mafrici Bruno, Rigby Mark, Harvey Daniel, Sharman Andrew, Allen Jennifer C, Mahajan Ravi, Gardner David S, Devonald Mark A J
Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK.
School of Medicine, University of Nottingham, Nottingham, UK.
Kidney Int Rep. 2019 May 23;4(8):1094-1108. doi: 10.1016/j.ekir.2019.05.001. eCollection 2019 Aug.
Malnutrition is common in patients with acute kidney injury (AKI), particularly in those requiring renal replacement therapy (RRT). Use of RRT removes metabolic waste products and toxins, but it will inevitably also remove useful molecules such as micronutrients, which might aggravate malnutrition. The RRT modalities vary in mechanism of solute removal; for example, intermittent hemodialysis (IHD) uses diffusion, continuous veno-venous hemofiltration (CVVH) uses convection, and sustained low-efficiency diafiltration (SLEDf) uses a combination of these.
We assessed micronutrient and amino acid losses in 3 different RRT modalities in patients with AKI (IHD, n = 27; SLEDf, n = 12; CVVH, n = 21) after correction for dialysis dose and plasma concentrations.
Total losses were affected by modality; generally CVVH >> SLEDf > IHD (e.g., amino acid loss was 18.69 ± 3.04, 8.21 ± 4.07, and 5.13 ± 3.1 g, respectively; < 0.001). Loss of specific trace elements (e.g., copper and zinc) during RRT was marked, with considerable heterogeneity between RRT types (e.g., +849 and +2325 μg/l lost during SLEDf vs. IHD, respectively), whereas effluent losses of copper and zinc decreased during CVVH (effect size relative to IHD, -3167 and -1442 μg/l, respectively). B vitamins were undetectable in effluent, but experimental modeling estimated 40% to 60% loss within the first 15 minutes of RRT.
Micronutrient and amino acid losses are marked during RRT in patients with AKI, with variation between RRT modalities and micronutrients.
营养不良在急性肾损伤（AKI）患者中很常见，尤其是在那些需要肾脏替代治疗（RRT）的患者中。使用RRT可清除代谢废物和毒素，但不可避免地也会清除诸如微量营养素等有用分子，这可能会加重营养不良。RRT模式在溶质清除机制上有所不同；例如，间歇性血液透析（IHD）利用扩散，连续性静脉-静脉血液滤过（CVVH）利用对流，而持续性低效透析滤过（SLEDf）则结合了这两种方式。
我们在校正透析剂量和血浆浓度后，评估了AKI患者（IHD组n = 27；SLEDf组n = 12；CVVH组n = 21）三种不同RRT模式下的微量营养素和氨基酸损失情况。
总损失受模式影响；一般来说CVVH >> SLEDf > IHD（例如，氨基酸损失分别为18.69±3.04、8.21±4.07和5.13±3.1克；<0.001）。RRT期间特定微量元素（如铜和锌）的损失很明显，不同RRT类型之间存在相当大的异质性（例如，SLEDf与IHD期间分别损失+849和+2325μg/l），而CVVH期间铜和锌的流出液损失减少（相对于IHD的效应量分别为-3167和-1442μg/l）。流出液中未检测到B族维生素，但实验模型估计在RRT的前15分钟内损失40%至60%。
AKI患者在RRT期间微量营养素和氨基酸损失明显，不同RRT模式和微量营养素之间存在差异。
