Journal List > J Nutr Health > v.48(3) > 1081388

J Nutr Health. 2015 Jun;48(3):211-220. Korean.
Published online June 30, 2015.  https://doi.org/10.4163/jnh.2015.48.3.211
© 2015 The Korean Nutrition Society
The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
Ju Yeun Kim,1 Ji-Myung Kim,2 and Yuri Kim1,3
1Department of Clinical Nutrition, The Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul 120-750, Korea.
2Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University, Gyeonggi 480-701, Korea.
3Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 120-750, Korea.

To whom correspondence should be addressed. tel: +82-2-3277-4485, Email: yuri.kim@ewha.ac.kr
Received February 23, 2015; Revised March 22, 2015; Accepted June 01, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

This study was designed to investigate whether nutritional supply influences biochemical markers and clinical outcomes in patients who received continuous renal replacement therapy (CRRT) by evaluating adequacy of nutritional supply for patients.

Methods

From January 2012 to December 2013, 239 adult patients who received CRRT in the intensive care unit for more than 3 days were included. General information from electronic medical records and nutritional status related biochemical data and clinical outcomes on the first day of CRRT and 2 weeks after CRRT were collected.

Results

The rate of delivered energy and protein was 68.06% and 43.13% which was much lower than energy and protein supply based on their requirement. When the patients were divided into two groups according to 70% of energy received rate and 50% of protein received rate, the group with more than 70% of energy received rate showed significant decrease of length of hospital stay (p = 0.007), length of stay in intensive care unit (ICU) (p = 0.008), duration of CRRT (p < 0.001), and APACHE II score (p < 0.001) compared to less than 70% of energy received rate after adjusting for age. In addition, the group with more than 50% of protein received rate showed decreased mortality (p = 0.031), length of hospital stay (p = 0.008), length of ICU stay (p = 0.035), duration of CRRT (p < 0.001), and APACHE II score (p < 0.001) after adjusting for age. We found that the level of hematocrit (p = 0.006) was significantly improved in the group with more than 70% of energy received rate, and the level of TLC (p = 0.049), hematocrit (p = 0.041) was significantly improved in the group with more than 50% of protein received rate. We also found that energy delivery was negatively correlated with length of stay in ICU (p = 0.049) and positively correlated with level of calcium (p = 0.037). In addition, protein delivery was correlated with the levels of serum total protein (p = 0.021), serum albumin (p = 0.048), hematocrit (p = 0.009), and total cholesterol (p = 0.021) when dead patients were included, but was correlated with the levels of hematocrit (p = 0.034) and calcium (p = 0.024) when dead patients were excluded.

Conclusion

Proper nutritional delivery may help patients' clinical outcomes for patients receiving CRRT. However, their actual intakes of energy and protein were not adequate for their requirements. Identification of patients with malnutrition is necessary and a multidisciplinary approach for systemic management is also required.

Keywords: continuous renal replacement therapy; energy support; protein support; clinical outcomes; nutritional status

Figures


Fig. 1
Study design. ICU, intensive care unit; CRRT, continuous renal replacement therapy.
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Tables


Table 1
General characteristics of subjects
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Table 2
Mean value of daily energy and protein supply in patients receiving CRRT
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Table 3
Comparisons of clinical outcomes according to rate of energy and protein supply
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Table 4
Comparisons of changes in biochemical markers according to rate of energy and protein supply between the first day of CRRT and 2 weeks after CRRT
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Table 5
Correlations energy and protein intake with clinical outcomes (Excluding dead patients, N = 128)
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Table 6
Correlations energy and protein intake with biochemical markers on 2 weeks after CRRT
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