Amino acid losses and nitrogen balance during slow diurnal hemodialysis in critically ill patients with renal failure

1997 ◽  
Vol 23 (1) ◽  
pp. 110-113 ◽  
Author(s):  
M. Kihara ◽  
Y. Ikeda ◽  
H. Fujita ◽  
M. Miura ◽  
S. Masumori ◽  
...  
Keyword(s):  
Renal Failure ◽  
Amino Acid ◽  
Critically Ill ◽  
Nitrogen Balance ◽  
Critically Ill Patients

Which Amino-Acids do Serum and Hemofiltrate of Critically Ill Patients with Acute Renal Failure Contain?

1997 ◽  
Vol 20 (6) ◽  
pp. 309-315 ◽  
Author(s):  
H-J. Guth ◽  
M. Wiersbitzky ◽  
M. Ziesche ◽  
H-J. Rose ◽  
G. Kraatz
Keyword(s):  
Amino Acids ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Lactic Acid ◽  
Amino Acid ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies

The removal of amino acids during continuous renal replacement therapies induces clinical problems. Previous studies on animals have shown nephroprotective (glycine, alanine) or negative effects (lysine) on renal function in occurrence of acute renal failure. Disturbed metabolism in acute renal failure needs adequate parenteral nutrition. On the other hand, experience with continuous renal replacement therapies of metabolic crises in inborn errors of metabolism indicate a good control of disturbed amino acid metabolism. The aim of our study was to find amino acids, that might play an important role in the pathogenesis, prognosis and detection of acute renal failure and severe illness, so far only estimated by lactic acid. Thirty-three probes (serum and hemofiltrate) were taken from patients, suffering with acute renal failure caused by septic shock, severe pancreatitis and hepatorenal syndrome, one hour after the beginning of extracorporal circulation, the conditions of treatment were standardized. The material was deproteinized and studied by the amino acid analyzer LBK 4251 Apha Plus (Pharmacia, Stockholm, Sweden), while the lactic acid concentration was determined in a standard laboratory. Proline, glycine, alanine, methionine and histidine showed a close relationship to the lactic acid levels, but these amino acids were an essential part of parenteral nutrition. A statistical relationship was also established in (amino acids with amide groups) asparagine, glutamine, citrulline, cystathionine and phosphoethanolamine. The mean values of most of the amino acids were higher than normal, but standard deviations were increased. The presence of these amino acids in hemofiltrate and the good sieving coefficients could mean that the better prognosis of critically ill patients in continuous renal replacement therapies may also be due to continuous control of amino acid levels (especially with amide groups).

Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients*

2002 ◽  
Vol 30 (9) ◽  
pp. 2051-2058 ◽  
Author(s):  
Philipp G. H. Metnitz ◽  
Claus G. Krenn ◽  
Heinz Steltzer ◽  
Thomas Lang ◽  
Jürgen Ploder ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Association of protein intake with the outcomes of critically ill patients: a post hoc analysis of the PermiT trial

2018 ◽  
Vol 108 (5) ◽  
pp. 988-996 ◽  
Author(s):  
Y M Arabi ◽  
H M Al-Dorzi ◽  
S Mehta ◽  
H M Tamim ◽  
S H Haddad ◽  
...  
Keyword(s):  
Propensity Score ◽  
Critically Ill ◽  
Nitrogen Balance ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Nitrogen Excretion ◽  
Post Hoc Analysis ◽  
Lower Protein ◽  
Protein Group ◽  
Post Hoc

ABSTRACT Background The optimal amount of protein intake in critically ill patients is uncertain. Objective In this post hoc analysis of the PermiT (Permissive Underfeeding vs. Target Enteral Feeding in Adult Critically Ill Patients) trial, we tested the hypothesis that higher total protein intake was associated with lower 90-d mortality and improved protein biomarkers in critically ill patients. Design In this post hoc analysis of the PermiT trial, we included patients who received enteral feeding for ≥3 consecutive days. Using the median protein intake of the cohort as a cutoff, patients were categorized into 2 groups: a higher-protein group (>0.80 g · kg–1 · d–1) and a lower-protein group (≤0.80 g · kg–1 · d–1). We developed a propensity score for receiving higher protein. Primary outcome was 90-d mortality. We also compared serial values of prealbumin, transferrin, 24-h urinary nitrogen, and 24-h nitrogen balance on days 1, 7, and 14. Results Among the 729 patients included in this analysis, the average protein intake was 0.8 ± 0.3 g · kg–1 · d–1 [1.0 ± 0.2 g · kg–1 · d–1 in the higher-protein group (n = 365) and 0.6 ± 0.2 g · kg–1 · d–1 in the lower-protein group (n = 364); P < 0.0001]. There was no difference in 90-d mortality between the 2 groups [88/364 (24.2%) compared with 94/363 (25.9%), propensity score–adjusted OR: 0.80; 95% CI: 0.56, 1.16; P = 0.24]. Higher protein intake was associated with an increase in 24-h urea nitrogen excretion compared with lower protein intake, but without a significant change in prealbumin, transferrin, or 24-h nitrogen balance. Conclusions In the PermiT trial, a moderate difference in protein intake was not associated with lower mortality. Higher protein intake was associated with increased nitrogen excretion in the urine without a corresponding change in prealbumin, transferrin, or nitrogen balance. Protein intake needs to be tested in adequately powered randomized controlled trials targeting larger differences in protein intake in high-risk populations.

IMPROVING QUALITY OF ASSISTANCE AND OUTCOME IN CRITICALLY ILL PATIENTS WITH ACUTE RENAL FAILURE

2006 ◽  
Vol 32 (3) ◽  
pp. 167-170
Author(s):  
P. Sclauzero ◽  
S. Casarotto ◽  
M. Martingano ◽  
F. Morpurgo ◽  
I. Rocconi ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Critically Ill ◽  
Critically Ill Patients
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