Clinical and nutritional factors associated with dialysis initiation and mortality in chronic kidney disease

BACKGROUND: Chronic kidney disease is worldwide recognized as a public health problem due to high rates of morbidity and mortality. At the end stage of the disease, which the glomerular filtration rate is equal or less than15 ml/min/1.73 m2, dialysis initiation is usually indicated. In the absence of a consensus on the best time of beginning, the aim of this study was to identify clinical and nutritional factors associated with clinical outcomes with the start of dialysis and death. METHODS: In a prospective cohort of 82 patients, clinical (underlying renal disease, renal survival time, systolic and diastolic blood pressure, estimated glomerular filtration rate) and nutritional data (protein intake, anthropometry, bioelectrical impedance test, and strength handgrip) were collected. We used mean and standard deviation ormedian and association of the variables with the outcome entry into dialysis or death, and a Cox regression model was applied. Statistical significance wasp< 0.05.RESULTS: Fifty-eight patients were included in group 1­G1 (without dialysis)­and 24 patients in group 2­G2(dialysis). The groups were different in blood urea nitrogen (p= <0.001), serum creatinine (p= 0.003), estimated glomerular filtration rate (p= 0.002), and serum phosphorus (p= 0.002). After multivariate analysis, only serumalbumin (HR 0.342,p= 0.004) and glomerular filtration rate (HR 0.001,p= 0.001) were associated with entry into dialysis and death. CONCLUSIONS: We concluded that lower levels of serum albumin and glomerular filtration rate values are associated with entry into dialysis or death.

Evaluation of energy metabolism in septic patients with and without AKI

BACKGROUND: The determination of resting energy expenditure (REE) in critically ill patients could prevent complications such as hypo- and hyper alimentation. This study aims to describe the REE in septic patients with and without acute kidney injury (AKI) and compare the REE estimated by the Harris-Benedict equation (HB) with the REE measured by indirect calorimetry (IC). METHODS: Prospective and observational study was performed. Septic patients older than 18 years, undergoing mechanical ventilation, with or without AKI defined by KDIGO criteria, and admitted to the Intensive Care Unit of University Hospital from Brazil were included. The REE was estimated by HB equation and measured by the IC within72 h after the diagnosis of sepsis and 7 days after the initial measure. RESULTS:Sixty-eight patients were evaluated, age was 62.5 ± 16.6 years, 64.7% were male, 63.2% had AKI, and SOFA was9.8 ± 2.35. The measured REE was 1857.5 ± 685.32 kcal, while the estimated REE was 1514.8 ± 356.72 kcal, with adequacy of 123.5 ± 43%. Septic patients without AKI (n= 25) and with AKI (n= 43) had measured REE statistically higher than the estimated one (1855.0 (1631.75­2052.75) vs. 1551.0 kcal (1349.0­1719.25),p= 0.007 and 1868.0(1219.5­2364.75) vs. 1388.0 kcal (1254.0­1665.5),p= 0.026, respectively). There was no significant difference between the two groups (with and without AKI) in measured and estimated REE (p= 0.63 and 0.64, respectively). There was no significant difference in evolutional REE (1845.95 ± 658.27 kcal vs. 1809.54 ± 755.08 kcal, p=0.86).CONCLUSIONS: The REE measured by IC was significantly higher than that estimated by HB equation in both septic with and without AKI. There was no significant difference in REE between the septic patients with and without AKI, suggesting that AKI does not influence the energy metabolism of septic patients.