2016, Number 2
Relationship of total parenteral nutrition administration and renal replacement therapy in the intensive care unit
PDF size: 209.93 Kb.
ABSTRACTIntroduction: Total parenteral nutrition (TPN) is a key factor for the treatment of critically ill patients. Nevertheless, the feasible complications of its use have not been completely investigated. We analyzed the relationship between TPN administration and renal replacement therapy (RRT) during the intensive care unit (ICU) stay.
Material and methods: We conducted a multicenter retrospective observational study in four ICUs. We obtained information on baseline characteristics, clinical data and outcomes from each hospital. We performed a statistical analysis to assess the association between TPN administration and RRT.
Results: A total of 3,491 patients were included to be studied. RRT was prescribed for 250 (7.1%) of them, and TPN for 367 (10.5%). After adjusting for various covariables, administration of TPN was independently related to RRT (OR 2.17, CI 95% [1.52-3.11]; p ‹ 0.001). The area under the ROC curve was 0.74 for the final regression model.
Conclusions: In this multicenter retrospective study, TPN administration was independently related to RRT during the ICU stay.
Alberda C, Gramlich L, Jones N, Jeejeebhoy K, Day AG, Dhaliwal R, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med. 2009;35(10):1728-1737.
Druml W, Kierdorf HP. Parenteral nutrition in patients with renal failure —Guidelines on parenteral nutrition, Chapter 17. Ger Med Sci. 2009;7:Doc11.
Ziegler TR. Parenteral nutrition in the critically ill patient. N Engl J Med. 2009;361(11):1088-1097.
Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004;20(10):843-848.
Kreymann KG, Berger MM, Deutz NEP, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006;25(2):210-223.
Brown RO, Compher C. ASPEN clinical guidelines: nutrition support in adult acute and chronic renal failure. JPEN J Parenter Enteral Nutr. 2010;34(4):366-377.
López Martínez J, Sánchez-Izquierdo Riera JA, Jiménez Jiménez FJ. Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parental and Enteral Nutrition (SEMICYUC-SENPE): acute renal failure. Med Intensiva. 2011;35 Suppl 1: 22-27.
Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003;27(5):355-373.
Kreymann G, Adolph M, Druml W, Jauch KW. Intensive medicine —Guidelines on Parenteral Nutrition, Chapter 14. Ger Med Sci. 2009;7:Doc14.
McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr. 2009;33(3):277-316.
Heidegger CP, Romand JA, Treggiari MM, Pichard C. Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? Intensive Care Med. 2007;33(6):963-969.
Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013;368(16):1489-1497.
Fiaccadori E, Cremaschi E. Nutritional assessment and support in acute kidney injury. Curr Opin Crit Care. 2009;15(6):474-480.
Montalvo-Jave EE, Zarraga JL, Sarr MG. Specific topics and complications of parenteral nutrition. Langenbecks Arch Surg. 2007;392(2):119-126.
Blanchette LM, Huiras P, Papadopoulos S. Standardized versus custom parenteral nutrition: impact on clinical and cost-related outcomes. Am J Health Syst Pharm. 2014;71(2):114-121.
Btaiche IF, Khalidi N. Metabolic complications of parenteral nutrition in adults, part 1. Am J Health Syst Pharm. 2004;61(18):1938-1949.
Li Y, Tang X, Zhang J, Wu T. Cochrane database of systematic reviews. The Cochrane database of systematic reviews. Chichester, UK: John Wiley & Sons, Ltd; 1996. CD005426 p.
Demircan M, Gurunluoglu K, Karaman A, Mizrak B. Damaging effects of total parenteral nutrition formula on vascular endothelium. J Pediatr Gastroenterol Nutr. 2015;61(4):464-468.
Dounousi E, Zikou X, Koulouras V, Katopodis K. Metabolic acidosis during parenteral nutrition: pathophysiological mechanisms. Indian J Crit Care Med. 2015;19(5):270-274.
Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41-55.
Walsh JF, Reznikoff M. Bootstrapping: a tool for clinical research. J Clin Psychol. 1990;46:928-930.
Hoste EAJ, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10(3):R73.
Rhee P, Hadjizacharia P, Trankiem C, Chan L, Salim A, Brown C, et al. What happened to total parenteral nutrition? The disappearance of its use in a trauma intensive care unit. J Trauma. 2007;63(6):1215-1222.
Gunst J, Vanhorebeek I, Casaer MP, Hermans G, Wouters PJ, Dubois J, et al. Impact of early parenteral nutrition on metabolism and kidney injury. J Am Soc Nephrol. 2013;24(6):995-1005.
Macias WL, Alaka KJ, Murphy MH, Miller ME, Clark WR, Mueller BA. Impact of the nutritional regimen on protein catabolism and nitrogen balance in patients with acute renal failure. JPEN J Parenter Enteral Nutr. 1996;20(1):56-62.
Fiaccadori E, Maggiore U, Rotelli C, Giacosa R, Picetti E, Parenti E, et al. Effects of different energy intakes on nitrogen balance in patients with acute renal failure: a pilot study. Nephrol Dial Transplant. 2005;20(9):1976-1980.
Zager RA. Amino acid hyperalimentation in acute renal failure: a potential therapeutic paradox. Kidney Int Suppl. 1987;22:S72-75.
Buchman AL, Moukarzel A, Ament ME, Gornbein J, Goodson B, Carlson C, et al. Serious renal impairment is associated with long-term parenteral nutrition. JPEN J Parenter Enteral Nutr. 1993;17(5):438-444.
Buchman AL. Complications of long-term home total parenteral nutrition. Dig Dis Sci. 2001;46(1):1-18.
Kato K, Sugiura S-I, Yano K, Fukuoka T, Itoh A, Nagino M, et al. The latent risk of acidosis in commercially available total parenteral nutrition (TPN) products: a randomized clinical trial in postoperative patients. J Clin Biochem Nutr. 2009;45(1):68-73.
Dudley J, Rogers R, Sealy L. Renal consequences of parenteral nutrition. Pediatr Nephrol. 2014;29(3):375-385.
Hartl WH, Jauch KW, Parhofer K, Rittler P. Complications and monitoring —Guidelines on Parenteral Nutrition, Chapter 11. Ger Med Sci. 2009;7:Doc17.