Mochizuki Masaki, Nakano Hidehiko, Ikechi Daisuke, Takahashi Yuji, Hashimoto Hideki, Nakamura Kensuke
Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, Ibaraki 317-0077, Japan.
J Clin Biochem Nutr. 2023 May;72(3):289-294. doi: 10.3164/jcbn.22-87. Epub 2023 Apr 6.
Adequate protein delivery is recommended in the acute phase of critical illness with kidney dysfunction. However, the influence of the protein and nitrogen loads has not yet been clarified. Patients admitted to the intensive care unit were included. In the former period, patients received standard care (0.9 g/kg/day protein). In the latter, patients received the intervention of active nutrition therapy with high protein delivery (1.8 g/kg/day protein). Fifty patients in the standard care group and 61 in the intervention group were examined. Maximum blood urea nitrogen (BUN) on days 7-10 were 27.9 (17.3, 38.6) vs 33 (26.3, 51.8) (mg/dl) ( = 0.031). The maximum difference in BUN increased [31.3 (22.8, 55) vs 50 (37.3, 75.9) mg/dl ( = 0.047)] when patients were limited to an estimated glomerular filtration rate (eGFR) <50 ml/min/1.73 m. This difference increased further when patients were limited to eGFR <30 ml/min/1.73 m. No significant differences were observed in maximum Cre or in the use of RRT. In conclusion, the provision of 1.8 g/kg/day protein was associated with an increase in BUN in critically ill patients with kidney dysfunction; however, it was tolerated without the need for RRT.
对于伴有肾功能不全的危重症急性期患者，建议给予充足的蛋白质供给。然而，蛋白质和氮负荷的影响尚未明确。纳入入住重症监护病房的患者。前期，患者接受标准治疗（0.9 g/kg/天蛋白质）。后期，患者接受高蛋白供给的积极营养治疗干预（1.8 g/kg/天蛋白质）。对标准治疗组的50例患者和干预组的61例患者进行了检查。第7 - 10天的最大血尿素氮（BUN）分别为27.9（17.3，38.6）和33（26.3，51.8）（mg/dl）（P = 0.031）。当将患者限制为估计肾小球滤过率（eGFR）<50 ml/min/1.73 m²时，BUN的最大差异增大[31.3（22.8，55）和50（37.3，75.9）mg/dl（P = 0.047）]。当将患者限制为eGFR <30 ml/min/1.73 m²时，这种差异进一步增大。最大肌酐或肾脏替代治疗（RRT）的使用方面未观察到显著差异。总之，对于伴有肾功能不全的危重症患者，给予1.8 g/kg/天蛋白质与BUN升高相关；然而，患者能够耐受，无需进行RRT。
