The nitrogen load is affected by high protein provision according to kidney function in critically ill patients.

IF 2 4区 医学 Q3 NUTRITION & DIETETICS Journal of Clinical Biochemistry and Nutrition Pub Date : 2023-05-01 DOI:10.3164/jcbn.22-87
Masaki Mochizuki, Hidehiko Nakano, Daisuke Ikechi, Yuji Takahashi, Hideki Hashimoto, Kensuke Nakamura
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Abstract

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) (p = 0.031). The maximum difference in BUN increased [31.3 (22.8, 55) vs 50 (37.3, 75.9) mg/dl (p = 0.047)] when patients were limited to an estimated glomerular filtration rate (eGFR) <50 ml/min/1.73 m2. This difference increased further when patients were limited to eGFR <30 ml/min/1.73 m2. 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.

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危重病人根据肾功能不同,高蛋白供给对氮负荷有影响。
建议在肾功能不全的危重疾病的急性期给予足够的蛋白质。然而,蛋白质和氮负荷的影响尚未明确。重症监护病房的病人也包括在内。在前一阶段,患者接受标准护理(0.9 g/kg/天蛋白质)。在后者中,患者接受高蛋白(1.8 g/kg/天蛋白)主动营养治疗的干预。标准治疗组50例,干预组61例。7 ~ 10 d血尿素氮(BUN)最大值分别为27.9(17.3,38.6)和33 (26.3,51.8)(mg/dl) (p = 0.031)。当患者仅限于估计肾小球滤过率(eGFR)时,BUN的最大差异增加[31.3 (22.8,55)vs 50 (37.3, 75.9) mg/dl (p = 0.047)]。当患者仅限于eGFR 2时,这种差异进一步增加。在最大Cre或RRT的使用方面没有观察到显著差异。综上所述,提供1.8 g/kg/d蛋白质与肾功能不全危重患者BUN升高相关;然而,它是耐受的,不需要RRT。
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来源期刊
CiteScore
4.30
自引率
8.30%
发文量
57
审稿时长
6-12 weeks
期刊介绍: Journal of Clinical Biochemistry and Nutrition (JCBN) is an international, interdisciplinary publication encompassing chemical, biochemical, physiological, pathological, toxicological and medical approaches to research on lipid peroxidation, free radicals, oxidative stress and nutrition. The Journal welcomes original contributions dealing with all aspects of clinical biochemistry and clinical nutrition including both in vitro and in vivo studies.
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