Therapeutic Nutrition of Patients Medically Managed by Continuous Renal Replacement Therapy atIntensive Care Units

Overview

The use of continuous renal replacement therapy (CRRT) can directly or indirectly influence patient’s metabolismand nutritional status. The loss of nutrients into the filtrate is significant. It concerns aminoacids, glucose,water-soluble vitamins, some minerals and trace elements. The loss of aminoacids is about 1.2 to 7.0 g per day. Theglucose balance during CRRT depends on the concentration of glucose in substitution solutions.When concentrationbetween 80 to 180 mg/dl is used, the glucose balance in most of patients is kept. The loss of lipids and lipid-solublevitamins is neglectable. From the micronutrients, significant becomes the loss of magnesium, calcium, phosphorusand that of water-soluble vitamins (mainly B1, B6, C and folic acid). Contrary to it, some components can crossfrom the substitution solution to the blood (e.g. lactate). Indirect effect of CRRT on the nutrition and metabolismrepresents the release of cytokins and inflammatory mediators resulting from the first contact of the blood with thefilter membrane. The decrese of glutamine level in the beginning of therapy is probably a consequence of thisinflammatory reaction. Nutritional plan of most of patients treated with CRRT is therefore necessary to adjust.

Key words:
nutrition, metabolism, hemodialysis, continuous renal replacement therapy, CRRT, intensive care, renalfailure.