Nutrition in Clinical Practice

 

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Nutrition in Clinical Practice, Vol. 20, No. 2, 176-191 (2005)
DOI: 10.1177/0115426505020002176

Invited Reviews

Metabolic and Nutritional Aspects of Acute Renal Failure in Critically Ill Patients Requiring Continuous Renal Replacement Therapy

Jennifer A. Wooley, MS, RD, CNSD*, Imad F. Btaiche, PharmD, BCNSP and Kelley L. Good, PharmD*

* Clinical Nutrition/Pharmacy, St Joseph Mercy Hospital, Ann Arbor, Michigan; and {ddagger}Department of Clinical Sciences, University of Michigan College of Pharmacy, and University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan

Correspondence: J. A. Wooley, MS, RD, CNSD, St Joseph Mercy Hospital, Clinical Nutrition/Pharmacy, 5301 East Huron River Dr, PO Box 995, Ann Arbor, MI 48106. Electronic mail may be sent to wooleyj{at}trinity-health.org.

Acute renal failure (ARF) is rarely an isolated process but is often a complication of underlying conditions such as sepsis, trauma, and multiple-organ failure in critically ill patients. As such, concomitant clinical conditions significantly affect patient outcome. Poor nutritional status is a major factor in increasing patients' morbidity and mortality. Malnutrition in ARF patients is caused by hypercatabolism and hypermetabolism that parallel the severity of illness. When dialytic intervention is indicated, continuous renal replacement therapy (CRRT) is a commonly used alternative to intermittent hemodialysis because it is well tolerated by hemodynamically unstable patients. This paper reviews the metabolic and nutritional alterations associated with ARF and provides recommendations regarding the nutritional, fluid, electrolyte, micronutrient, and acid-base management of these patients. The basic principles of CRRT are addressed, along with their nutritional implications in critically ill patients. A patient case is presented to illustrate the clinical application of topics covered within the paper.


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