Department of Critical Care, Guy's & St Thomas' Hospital, London, UK.
Division of Nephrology, Department of Internal Medicine and Excellence Center in Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Semin Dial. 2021 Nov;34(6):449-456. doi: 10.1111/sdi.12973. Epub 2021 Apr 28.
Malnutrition is highly prevalent in patients with acute kidney injury, especially in those receiving renal replacement therapy (RRT). For the assessment of nutritional status, a combination of screening tools, anthropometry, and laboratory parameters is recommended rather than a single test. To avoid underfeeding and overfeeding during RRT, energy expenditure should be measured by indirect calorimetry or calculated using predictive equations. Nitrogen balance should be periodically measured to assess the degree of catabolism and to evaluate protein intake. However, there is limited data for nutritional targets specifically for patients on RRT, such as protein intake. The composition of commercial solutions for continuous renal replacement therapy (CRRT) varies. CRRT itself can be associated with both, nutrient losses into the effluent fluid and caloric gain from dextrose, lactate, and citrate. The role of micronutrient supplementation, and potential use of micronutrient enriched CRRT solutions in this setting is unknown, too. This review provides an overview of existing knowledge and uncertainties related to nutritional aspects in patients on CRRT and emphasizes the need for more research in this area.
营养不良在急性肾损伤患者中非常普遍，尤其是在接受肾脏替代治疗（RRT）的患者中。对于营养状况的评估，建议结合使用筛选工具、人体测量学和实验室参数，而不是单一的测试。为了避免在 RRT 期间出现喂养不足和过度喂养，应通过间接测热法测量能量消耗或使用预测方程计算。应定期测量氮平衡，以评估分解代谢的程度和蛋白质摄入情况。然而，针对接受 RRT 的患者的营养目标，例如蛋白质摄入，目前的数据有限。用于连续肾脏替代治疗（CRRT）的商业溶液的成分各不相同。CRRT 本身可能会导致营养物质丢失到流出液中，同时从葡萄糖、乳酸盐和柠檬酸盐中获得热量。关于在这种情况下补充微量营养素以及潜在使用富含微量营养素的 CRRT 溶液的作用，目前还知之甚少。本篇综述提供了有关接受 CRRT 患者营养方面的现有知识和不确定性的概述，并强调了在这一领域需要更多的研究。
