Influence of different dialysis modalities in the measurement of resting energy expenditure in patients with acute kidney injury in ICU
A new prospective cohort study published on ESPEN's Clinical Nutrition Journal evaluated the role and the feasibility of indirect calorimetry (IC) among patients admitted in intensive care units with diagnosis of acute kidney injury (AKI).
A key issue on these patients is that general recommendations suggest to not perform IC during dialysis, but this may preclude EE measurement and hinder nutritional therapy in these patients. The present study aims to evaluate the resting energy expenditure (REE) measured by IC of severe AKI patients undergoing different dialysis modalities, and identify if dialysis influences REE.
Three different dialysis were considered in this study:
- High volume peritoneal dialysis (HVPD)
- Conventional Hemodialysis (CHD)
- Extended Hemodialysis (EHD)
Indirect calorimetry was performed using calorimeter a Quark RMR unit. The exam lasted 30 min on average. It was desired that patients reached steady state during the test. The steady state was defined as a variation <10% in the oxygen consumption measurements (VO2) and carbon dioxide production (VCO2), and <5% in respiratory quotient in every minute. In addition to REE measured in two moments, parameters that can influence REE were also evaluated, as ventilatory parameters (minute volume, total current volume, PEEP, FIO2), continue sedation and vasoactive drugs during all measurements.
The study findings confirmed that "IC can be performed during these dialysis procedures (CHD, EHD and HVPD). There was no difference between ventilation parameters, sedatives use, body temperature and VAD in both moments. Thus, IC measure contraindication in this modality is not yet proven correct. Therefore, further studies are needed to evaluate REE during continuous renal replacement therapy (RRT), and the real interference in IC measurement, aiming improvement on nutritional advice for critically ill patients with severe AKI".
The article details are the following:
- Title: "Influence of different dialysis modalities in the measurement of resting energy expenditure in patients with acute kidney injury in ICU"
- Authors: Cassiana R. de Góes, Barbara Perez Vogt, Ana Claudia S. Sanches, André L. Balbi, Daniela Ponce
- Published in: Clinical Nutrition xxx (2016) 1e5
The full study can be purchased at the following link: click here
