Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland.
Perioperative and Intensive Care, Skåne University Hospital, Lund, Sweden.
Curr Opin Crit Care. 2021 Aug 1;27(4):367-377. doi: 10.1097/MCC.0000000000000851.
Malnutrition is frequent in patients with acute kidney injury. Nutrient clearance during renal replacement therapy (RRT) potentially contributes to this complication. Although losses of amino acid, trace elements and vitamins have been described, there is no clear guidance regarding the role of micronutrient supplementation.
A scoping review was conducted with the aim to review the existing literature on micronutrients status during RRT: 35 publications including data on effluent losses and blood concentrations were considered relevant and analysed. For completeness, we also included data on amino acids. Among trace elements, negative balances have been shown for copper and selenium: low blood levels seem to indicate potential deficiency. Smaller size water soluble vitamins were found in the effluent, but not larger size liposoluble vitamins. Low blood values were frequently reported for thiamine, folate and vitamin C, as well as for carnitine. All amino acids were detectable in effluent fluid. Duration of RRT was associated with decreasing blood values.
Losses of several micronutrients and amino acids associated with low blood levels represent a real risk of deficiency for vitamins B1 and C, copper and selenium: they should be monitored in prolonged RRT. Further Research is urgently required as the data are insufficient to generate strong conclusions and prescription recommendations for clinical practice.
急性肾损伤患者常发生营养不良。肾脏替代治疗（RRT）期间的营养清除可能导致这种并发症。尽管已经描述了氨基酸、微量元素和维生素的丢失，但对于微量营养素补充的作用尚没有明确的指导。
进行了范围性综述，旨在综述 RRT 期间微量营养素状态的现有文献：纳入了 35 篇相关出版物，分析了其关于流出物损失和血液浓度的数据。为了完整性，我们还纳入了关于氨基酸的数据。在微量元素中，铜和硒显示出负平衡：低血液水平似乎表明存在潜在的缺乏。较小的水溶性维生素在流出物中被发现，但较大的脂溶性维生素没有。血液中维生素 B1、叶酸和维生素 C 以及肉碱的水平较低，经常有报道。所有的氨基酸都可以在流出液中检测到。RRT 的持续时间与血液值的降低有关。
与低血液水平相关的几种微量营养素和氨基酸的丢失代表了维生素 B1 和 C、铜和硒缺乏的真正风险：在长时间的 RRT 中应监测这些元素。由于数据不足以得出强烈的结论和为临床实践提供处方建议，因此迫切需要进一步的研究。
