title: Calorie intake and patient outcomes in severe acute kidney injury: findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial.
abstract: BACKGROUND
  Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes.
  
  
  METHODS
  We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models.
  
  
  RESULTS
  Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling.
  
  
  CONCLUSIONS
  In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes.
  
  
  BACKGROUND
  ClinicalTrials.gov number, NCT00221013.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Louise
authors.initials: L
authors.lastname: Cole
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
authors.forename: Joanne
authors.initials: J
authors.lastname: Lee
authors.forename: Serigne
authors.initials: S
authors.lastname: Lo
authors.forename: Colin
authors.initials: C
authors.lastname: McArthur
authors.forename: Shay
authors.initials: S
authors.lastname: McGuinness
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.forename: Robyn
authors.initials: R
authors.lastname: Norton
authors.forename: Carlos
authors.initials: C
authors.lastname: Scheinkestel
authors.forename: Steve
authors.initials: S
authors.lastname: Su
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D002149:Energy Intake / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000401:mortality* / Q000639:trends; D012720:Severity of Illness Index; D016896:Treatment Outcome