title: Short-term consequences of continuous renal replacement therapy on body composition and metabolic status in sepsis.
abstract: OBJECTIVE
  Fluid overload and hypermetabolism frequently occur in sepsis patients in the intensive care unit (ICU) setting. These abnormalities correlate with inflammatory mediators released under stressful conditions. Continuous renal replacement therapy (CRRT) is an extracorporeal life support technology that persistently and stably eliminates overhydration and cytokines. This study investigated the short-term consequence of CRRT on body composition and pattern of energy expenditure.
  
  
  METHODS
  We prospectively observed 27 sepsis patients in our ICU treated with CRRT. Bioelectrical impedance analysis and indirect calorimetry were determined at admission and before and after CRRT. All parameters considered to affect body composition and metabolic state with short-term CRRT were recorded. We used correlation analysis to evaluate the relationship between the change of nutritional state and other parameters.
  
  
  RESULTS
  Patients had a decreased total body water load and an improved metabolic pattern, but the nutritional parameters had no significant change between pre- and post-CRRT. Furthermore, we observed the percentage variation of resting energy expenditure (REE) was positively correlated with intracellular water change (r=0.547, p=0.003) and CRRT duration (r=0.515, p=0.006). A negative correlation was found between the percentage variation of REE and dialysate temperature (r=-0.668, p=0.001).
  
  
  CONCLUSIONS
  These results suggest that short-term CRRT reduces systemic volume in sepsis patients with overhydration and hypermetabolism, but has no significant impact on acute nutritional status. Meanwhile, CRRT may exert its optimum efficiency when accompanied by other medical practices and support methods.
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China. Email: ptwklining@163.com; njwxinying@126.com.
authors.forename: Xinying
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Wenkui
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China.
authors.forename: Sitong
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
mesh_terms: D001823:Body Composition / Q000502:physiology*; D001834:Body Water; D002153:Calorimetry, Indirect; D003422:Critical Care; D017097:Electric Impedance; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D018805:Sepsis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*