Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden.
Nephrology Unit, Parma University Hospital, & Department of Medicine and Surgery, University of Parma, Parma, Italy.
Clin Nutr. 2024 Sep;43(9):2238-2254. doi: 10.1016/j.clnu.2024.08.002. Epub 2024 Aug 20.
Hospitalized patients often have acute kidney disease (AKD) or chronic kidney disease (CKD), with important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, the possible impact on nutritional requirements cannot be neglected. On this regard, the present guideline aims to provide evidence-based recommendations for clinical nutrition in hospitalized patients with KD.
The standard operating procedure for ESPEN guidelines was used. Clinical questions were defined in both the PICO format, and organized in subtopics when needed, and in non-PICO questions for the more general topics. The literature search was from January 1st, 1999 until January 1st, 2020. Each question led to one or more recommendation/statement and related commentaries. Existing evidence was graded, as well as recommendations and statements were developed and agreed upon in a multistage consensus process.
The present guideline provides 32 evidence-based recommendations and 8 statements, defining how to assess nutritional status, how to define patients at risk, how to choose the route of feeding, and how to integrate nutrition with KRT. In the final online voting, a strong consensus was reached in 84% at least of recommendations and 100% of statements.
The presence of KD in hospitalized patients identifies a highly heterogeneous group of subjects with widely varying nutrient needs and intakes. Considering the high nutritional risk related with this clinical condition, an individualized approach consisting of nutritional status evaluation and monitoring, frequent evaluation of nutritional requirements, and careful integration with KRT should be planned to avoid both underfeeding and overfeeding. Practical recommendations and statements were developed, aiming at defining suggestions for everyday clinical practice in the individualization of nutritional support in this patient setting. Literature areas with scarce or without evidence were also identified, thus requiring further basic or clinical research.
住院患者常患有急性肾疾病（AKD）或慢性肾脏疾病（CKD），会带来重要的代谢和营养后果。此外，如果开始肾脏替代治疗（KRT），则不能忽视其对营养需求的可能影响。关于这一点，本指南旨在为 KD 住院患者的临床营养提供循证建议。
ESPEN 指南的标准操作程序被用于本研究。临床问题以 PICO 格式定义，并在需要时组织成子主题，对于更一般的主题则采用非 PICO 问题。文献检索从 1999 年 1 月 1 日至 2020 年 1 月 1 日。每个问题都会导致一个或多个建议/声明和相关评论。现有的证据被分级，建议和声明是在多阶段共识过程中制定和达成的。
本指南提供了 32 条基于证据的建议和 8 条声明，定义了如何评估营养状况，如何定义有风险的患者，如何选择喂养途径，以及如何将营养与 KRT 相结合。在最终的在线投票中，至少 84%的建议和 100%的声明达成了强烈共识。
KD 住院患者是一组高度异质的患者，他们的营养需求和摄入量差异很大。考虑到这种临床情况与高营养风险相关，应计划采用个体化方法，包括营养状况评估和监测、频繁评估营养需求以及与 KRT 的精心整合，以避免喂养不足和过度喂养。本研究制定了实用的建议和声明，旨在为个体化营养支持在这一患者群体中的日常临床实践定义建议。本研究还确定了文献中证据匮乏或缺乏的领域，因此需要进一步进行基础或临床研究。
