12 February 2021
ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease
Acute kidney disease (AKD) and chronic kidney disease (CKD) are highly prevalent among hospitalized patients and they have important metabolic and nutritional consequences. Moreover, in case of kidney replacement therapy the possible impact on nutritional profiles, substrate balance, and nutritional treatment processes cannot be neglected.
The presence of AKD or CKD identifies a highly heterogeneous group of subjects with widely varying nutrient needs and intakes. However, since all of these patients are at high risk for malnutrition, nutritional status should be thoroughly assessed. Also, nutritional requirements should be frequently evaluated in their quantitative and qualitative aspects, individualized, and carefully integrated with KRT, to avoid both underfeeding and overfeeding.
The present guideline is aimed at providing evidence-based recommendations for clinical nutrition in hospitalized patients with AKD and CKD. The decisive role of Indirect Calorimetry is outlined:
« In hospitalized patients with AKI/AKD and/or CKD or CKD with KF needing medical nutrition therapy, indirect calorimetry should be used to assess energy expenditure to guide nutritional therapy (caloric dosing) and avoid under- or overfeeding. »
Grade of recommendation B e Strong consensus (95.7% agreement)
« Indirect calorimetry can be performed during CKRT, bearing in mind the intrinsic limitations of the method. A minimum interval of 2 h after an intermittent dialysis session should be preferred to improve the precision of the measurement. »
Grade of recommendation 0 e Consensus (78.3% agreement)
« Whenever the clinical condition of the patient is changing, indirect calorimetry shall be repeated. »
Grade of recommendation GPP e Strong consensus (100% agreement).
« In hospitalized patients with AKI/AKD and/or CKD or CKD with KF needing medical nutrition the amount of lipids and carbohydrates may be combined to increase lipid intake and reduce carbohydrate provision based on real substrate utilization assessed by indirect calorimetry. »
Grade of recommendation 0 e Strong consensus (91.3% agreement)
- Title: ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease
- Authors: Enrico Fiaccadori, Alice Sabatino, Rocco Barazzoni, Juan Jesus Carrero, Adamasco Cupisti, Elisabeth De Waele, Joop Jonckheer, Pierre Singer, Cristina Cuerda
- Published in: Clinical Nutrition - February 2021
- Link: https://doi.org/10.1016/j.clnu.2021.01.028