Druml Wilfred, Staudinger Thomas, Joannidis Michael
Division of Nephrology, Department of Medicine III, Vienna General Hospital, Währingergürtel 18-20, 1090, Vienna, Austria.
Department of Medicine I, Intensive Care Unit 13i2, Vienna General Hospital, Währingergürtel 18-20, 1090, Vienna, Austria.
Crit Care. 2024 Aug 7;28(1):266. doi: 10.1186/s13054-024-05052-5.
Most randomized controlled studies on nutrition in intensive care patients did not yield conclusive results or were neutral or negative concerning the primary endpoints but also in most secondary endpoints. However, there is a consistent observation that in several of these studies there was a negative effect of the nutrition intervention on the kidneys in one of the study arms. During the early phase and in unstable periods during further course of disease an inadequate clinical nutrition can damage the kidneys, can elicit or aggravate acute kidney injury and/ or increase requirements of renal replacement therapy (RRT). This relates to total energy intake, glucose intake/hyperglycemia and protein/ amino acid intake at various stages of renal dysfunction. The kidney could present a critical organ system for guiding nutrition therapy, a close monitoring of kidney function should be observed and nutrition therapy may need to be adapted accordingly. The long-held dogma of performing full nutrition and accept an otherwise not necessary RRT is definitely to be refuted.
大多数关于重症监护患者营养的随机对照研究并未得出确凿结果，对于主要终点以及大多数次要终点而言，结果呈中性或阴性。然而，有一个一致的观察结果是，在其中几项研究中，营养干预在其中一个研究组对肾脏产生了负面影响。在疾病早期和疾病进一步发展的不稳定阶段，临床营养不足会损害肾脏，引发或加重急性肾损伤和/或增加肾脏替代治疗（RRT）的需求。这与肾功能不全各个阶段的总能量摄入、葡萄糖摄入/高血糖以及蛋白质/氨基酸摄入有关。肾脏可能是指导营养治疗的关键器官系统，应密切监测肾功能，并且营养治疗可能需要相应调整。长期以来坚持的进行充分营养并接受原本不必要的RRT的教条肯定要被驳斥。
