title: Impact of early parenteral nutrition on metabolism and kidney injury.
abstract: A poor nutritional state and a caloric deficit associate with increased morbidity and mortality, but a recent multicenter, randomized controlled trial found that early parenteral nutrition to supplement insufficient enteral nutrition increases morbidity in the intensive care unit, including prolonging the duration of renal replacement therapy, compared with withholding parenteral nutrition for 1 week. Whether early versus late parenteral nutrition impacts the incidence and recovery of AKI is unknown. Here, we report a prespecified analysis from this trial, the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The timing of parenteral nutrition did not affect the incidence of AKI, but early initiation seemed to slow renal recovery in patients with stage 2 AKI. Early parenteral nutrition did not affect the time course of creatinine and creatinine clearance but did increase plasma urea, urea/creatinine ratio, and nitrogen excretion beginning on the first day of amino acid infusion. In the group that received late parenteral nutrition, infusing amino acids after the first week also increased ureagenesis. During the first 2 weeks, ureagenesis resulted in net waste of 63% of the extra nitrogen intake from early parenteral nutrition. In conclusion, early parenteral nutrition does not seem to impact AKI incidence, although it may delay recovery in patients with stage 2 AKI. Substantial catabolism of the extra amino acids, which leads to higher levels of plasma urea, might explain the prolonged duration of renal replacement therapy observed with early parenteral nutrition.
authors.affiliation: Clinical Department, KU Leuven, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Gunst
authors.forename: Ilse
authors.initials: I
authors.lastname: Vanhorebeek
authors.forename: Michaël P
authors.initials: MP
authors.lastname: Casaer
authors.forename: Greet
authors.initials: G
authors.lastname: Hermans
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Wouters
authors.forename: Jasperina
authors.initials: J
authors.lastname: Dubois
authors.forename: Kathleen
authors.initials: K
authors.lastname: Claes
authors.forename: Miet
authors.initials: M
authors.lastname: Schetz
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000178:diet therapy* / Q000378:metabolism* / Q000401:mortality; D000368:Aged; D000581:Amidohydrolases / Q000097:blood; D000596:Amino Acids / Q000008:administration & dosage; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010288:Parenteral Nutrition / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D014556:Urine
chemical_list: D000596:Amino Acids; D000581:Amidohydrolases; C019946:creatininase
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