title: Protein Requirements for Critically Ill Patients With Renal and Liver Failure.
abstract: Diseases leading to critical illness induce proteolysis resulting in muscle wasting and negative nitrogen balance. Muscle wasting has been associated with poor intensive care unit (ICU)-related outcomes, including an increased risk for mortality. Acute kidney injury (AKI) represents a common organ dysfunction associated with ICU-related disorders, such as sepsis, trauma, and respiratory failure. AKI and renal replacement therapy lead to amino acid loss. Decompensated liver cirrhosis (DLC) and acute liver failure (ALF) represent more severe forms of liver dysfunction leading to ICU admission. DLC and ALF are associated with proteolysis and amino acid loss. AKI, DLC, and ALF uniquely contribute to negative nitrogen balance. The purpose of this review is to outline proteolysis associated with critical illness; define specific protein abnormalities in AKI, DLC, and ALF; define protein requirements in AKI, DLC, and ALF; and discuss barriers associated with optimal protein supplementation in these disorders.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Jayshil J
authors.initials: JJ
authors.lastname: Patel
authors.affiliation: 2 Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Pharmacology and Toxicology, University of Louisville, and Robley Rex VA Medical Center, Louisville, Kentucky, USA.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: McClain
authors.affiliation: 3 Division of Nephrology, Department of Medicine, NorthShore University Hospital Health System, University of Chicago, Chicago, Illinois, USA.
authors.forename: Menaka
authors.initials: M
authors.lastname: Sarav
authors.affiliation: 4 Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Hamilton-Reeves
authors.affiliation: 5 Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
mesh_terms: D058186:Acute Kidney Injury; D016638:Critical Illness; D004044:Dietary Proteins; D006801:Humans; D007362:Intensive Care Units; D017093:Liver Failure; D009751:Nutritional Requirements
chemical_list: D004044:Dietary Proteins
keywords: acute kidney injury; acute liver failure; amino acids; catabolism; critical care; decompensated liver cirrhosis; dietary proteins; protein requirements