Influence of kidney replacement therapy on indirect calorimetry in critically ill patients.

IF 3.3 3区医学 Q2 NUTRITION & DIETETICS

European Journal of Clinical Nutrition Pub Date : 2025-07-30 DOI:10.1038/s41430-025-01643-9

Annalena Knoll, Sirak Petros, Bastian Pasieka, Lorenz Weidhase

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引用次数: 0

Abstract

Background: Kidney replacement therapy (KRT) is frequently implemented in the intensive care unit. While measuring energy expenditure is recommended in the critically ill, the influence of KRT on indirect calorimetry (IC) is not fully clear. This prospective study aimed to investigate the influence of continuous veno-venous hemodialysis (CVVHD) and slow extended daily dialysis (SLEDD) on IC variables.

Patients and methods: We included critically ill mechanically ventilated adult medical patients on KRT for acute kidney injury. CVVHD was run with regional citrate anticoagulation, while SLEDD with systemic heparin anticoagulation. We conducted IC twice on every patient, either immediately before the planned termination of KRT and then an hour after the end of KRT or immediately before commencement of KRT and then again after an hour on KRT.

Results: We included 100 patients (75 males) with a median age of 64.0 years, a mean APACHE-II score of 30.9 and a mean SOFA score of 11.3 on the day of IC. There was no significant difference in median resting energy expenditure with versus without CVVHD (8029 [6993-9644] versus 7814 [6962-9304] kJ, p = 0.75) as well as with versus without SLEDD (9258 [8017-10,364] versus 9269 [8070-11,065] kJ, p = 0.63). The difference in resting energy expenditure between the two measurements was also not significant regardless of the sequence of IC measurements (p = 0.69).

Conclusion: This prospective study on critically ill adult patients did not show any significant difference for indirect calorimetry variables between measurements conducted during CVVHD and SLEDD compared to those without KRT.

Clinicaltrials: gov ID: NCT04599569.

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肾脏替代治疗对危重病人间接量热的影响。

背景：肾脏替代疗法（KRT）经常在重症监护病房实施。虽然在危重患者中推荐测量能量消耗，但KRT对间接量热法（IC）的影响尚不完全清楚。本前瞻性研究旨在探讨持续静脉-静脉血液透析（CVVHD）和缓慢延长每日透析（SLEDD）对IC变量的影响。患者和方法：我们纳入了重症机械通气成人医学患者KRT急性肾损伤。CVVHD组采用局部柠檬酸盐抗凝，SLEDD组采用全身肝素抗凝。我们对每位患者进行了两次IC，一次是在KRT计划终止前，一次是在KRT结束后一小时，或者是在KRT开始前，一次是在KRT开始一小时后。结果：我们纳入了100例患者（75名男性），中位年龄为64.0岁，IC当天的APACHE-II平均评分为30.9，SOFA平均评分为11.3。CVVHD组与非CVVHD组的中位静息能量消耗（8029[6993-9644]对7814 [6962-9304]kJ， p = 0.75）以及SLEDD组与非SLEDD组的中位静息能量消耗（9258[8017- 10364]对9269 [8070- 11065]kJ， p = 0.63）无显著差异。无论IC测量的顺序如何，两种测量之间的静息能量消耗差异也不显著（p = 0.69）。结论：这项对危重成人患者的前瞻性研究显示，与没有KRT的患者相比，CVVHD和SLEDD期间进行的间接量热变量测量没有显着差异。临床试验：gov ID: NCT04599569。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Nutrition 医学-营养学

CiteScore

10.60

自引率

2.10%

发文量

189

审稿时长

3-6 weeks

期刊介绍： The European Journal of Clinical Nutrition (EJCN) is an international, peer-reviewed journal covering all aspects of human and clinical nutrition. The journal welcomes original research, reviews, case reports and brief communications based on clinical, metabolic and epidemiological studies that describe methodologies, mechanisms, associations and benefits of nutritional interventions for clinical disease and health promotion. Topics of interest include but are not limited to: Nutrition and Health (including climate and ecological aspects) Metabolism & Metabolomics Genomics and personalized strategies in nutrition Nutrition during the early life cycle Health issues and nutrition in the elderly Phenotyping in clinical nutrition Nutrition in acute and chronic diseases The double burden of ''malnutrition'': Under-nutrition and Obesity Prevention of Non Communicable Diseases (NCD)