title: In vitro glucose kinetics during continuous renal replacement therapy: implications for caloric balance in critically ill patients.
abstract: OBJECTIVE
  To examine the impact of continuous renal replacement therapy (CRRT) on glucose kinetics and therefore caloric balance.
  
  
  METHODS
  In vitro experiments were conducted to characterize glucose kinetics in a variety of CRRT modalities and prescriptions. Additional experiments evaluated the impact of citrate anticoagulation using anti-coagulant dextrose solution A (ACD-A) on CRRT glucose movement. A formula was developed to predict the glucose delivery to/from the patient per day of CRRT, and this data was extrapolated to determine the net caloric impact of CRRT.
  
  
  RESULTS
  A total of 104 experiments were conducted with an overall glucose extraction coefficient of 1.04 (95% CI 1.03-1.05). CRRT-related glucose removal was directly related to effluent (dialysate and/or hemofiltration) rate and pre-filter blood glucose concentration, and inversely related to dialysis solution glucose concentration. In all modalities tested, CRRT resulted in a net negative glucose balance, with estimated caloric losses ranging between 20 kcal and 550 kcal depending on the conditions tested. The addition of ACD-A resulted in net glucose delivery in some conditions and a positive caloric balance of up to 470 kcal per day.
  
  
  CONCLUSIONS
  CRRT can have a significant effect on glucose balance and result in either significant daily caloric gains or losses, and this effect can be predicted based on CRRT prescription and patient characteristics. Clinicians should be aware of this potential impact when prescribing nutritional therapy to patients undergoing CRRT, as an imbalance in caloric feeding can adversely affect outcomes in critically ill patients.
authors.affiliation: University of Michigan College of Pharmacy, Ann Arbor, MI - USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Stevenson
authors.forename: Michael
authors.initials: M
authors.lastname: Heung
authors.forename: A Mary
authors.initials: AM
authors.lastname: Vilay
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Eyler
authors.forename: Chirag
authors.initials: C
authors.lastname: Patel
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Mueller
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000494:pharmacology; D002417:Cattle; D019343:Citric Acid / Q000378:metabolism* / Q000494:pharmacology; D016638:Critical Illness; D015314:Dialysis Solutions / Q000378:metabolism* / Q000494:pharmacology; D002149:Energy Intake / Q000187:drug effects; D004734:Energy Metabolism / Q000187:drug effects; D005947:Glucose / Q000031:analogs & derivatives* / Q000378:metabolism* / Q000494:pharmacology; D006706:Homeostasis; D006801:Humans; D007700:Kinetics; D008954:Models, Biological; D017582:Renal Replacement Therapy
chemical_list: D000925:Anticoagulants; D015314:Dialysis Solutions; C002113:acid citrate dextrose; D019343:Citric Acid; D005947:Glucose