title: The Impact of Macro-and Micronutrients on Predicting Outcomes of Critically Ill Patients Requiring Continuous Renal Replacement Therapy.
abstract: Critically ill patients with acute kidney injury (AKI) who receive renal replacement therapy (RRT) have very high mortality rate. During RRT, there are markedly loss of macro- and micronutrients which may cause malnutrition and result in impaired renal recovery and patient survival. We aimed to examine the predictive role of macro- and micronutrients on survival and renal outcomes in critically ill patients undergoing continuous RRT (CRRT). This prospective observational study enrolled critically ill patients requiring CRRT at Intensive Care Unit of King Chulalongkorn Memorial Hospital from November 2012 until November 2013. The serum, urine, and effluent fluid were serially collected on the first three days to calculate protein metabolism including dietary protein intake (DPI), nitrogen balance, and normalized protein catabolic rate (nPCR). Serum zinc, selenium, and copper were measured for micronutrients analysis on the first three days of CRRT. Survivor was defined as being alive on day 28 after initiation of CRRT.Dialysis status on day 28 was also determined. Of the 70 critically ill patients requiring CRRT, 27 patients (37.5%) survived on day 28. The DPI and serum albumin of survivors were significantly higher than non-survivors (0.8± 0.2 vs 0.5 ±0.3g/kg/day, p = 0.001, and 3.2±0.5 vs 2.9±0.5 g/dL, p = 0.03, respectively) while other markers were comparable. The DPI alone predicted patient survival with area under the curve (AUC) of 0.69. A combined clinical model predicted survival with AUC of 0.78. When adjusted for differences in albumin level, clinical severity score (APACHEII and SOFA score), and serum creatinine at initiation of CRRT, DPI still independently predicted survival (odds ratio 4.62, p = 0.009). The serum levels of micronutrients in both groups were comparable and unaltered following CRRT. Regarding renal outcome, patients in the dialysis independent group had higher serum albumin levels than the dialysis dependent group, p = 0.01. In conclusion, in critically ill patients requiring CRRT, DPI is a good predictor of patient survival while serum albumin is a good prognosticator of renal outcome.
authors.affiliation: Division of Nephrology, Department of Medicine, Konkaen University, Konkaen, Thailand.
authors.forename: Kittrawee
authors.initials: K
authors.lastname: Kritmetapak
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Sadudee
authors.initials: S
authors.lastname: Peerapornratana
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Nattachai
authors.identifier: http://orcid.org/0000-0002-8544-8132
authors.initials: N
authors.lastname: Srisawat
authors.affiliation: Division of Clinical Nutrition, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Nicha
authors.initials: N
authors.lastname: Somlaw
authors.affiliation: Division of Clinical Nutrition, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Narisorn
authors.initials: N
authors.lastname: Lakananurak
authors.affiliation: Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Thasinas
authors.initials: T
authors.lastname: Dissayabutra
authors.affiliation: Division of Nephrology, Department of Medicine, Konkaen University, Konkaen, Thailand.
authors.forename: Chayanat
authors.initials: C
authors.lastname: Phonork
authors.affiliation: Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Asada
authors.initials: A
authors.lastname: Leelahavanichkul
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Khajohn
authors.initials: K
authors.lastname: Tiranathanagul
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Paweena
authors.initials: P
authors.lastname: Susantithapong
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Passisd
authors.initials: P
authors.lastname: Loaveeravat
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Nattachai
authors.initials: N
authors.lastname: Suwachittanont
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Thaksa-On
authors.initials: TO
authors.lastname: Wirotwan
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Kearkiat
authors.initials: K
authors.lastname: Praditpornsilpa
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Kriang
authors.initials: K
authors.lastname: Tungsanga
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Somchai
authors.initials: S
authors.lastname: Eiam-Ong
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Piyawan
authors.initials: P
authors.lastname: Kittiskulnam
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000628:therapy; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016638:Critical Illness; D004044:Dietary Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000097:blood*; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D004044:Dietary Proteins; D018977:Micronutrients; D012709:Serum Albumin