ABSTRACT
OBJECTIVE: To assess the nutritional status of critically ill patients with acute renal failure on continuous renal replacement therapy (CRRT) and their protein needs by estimating the protein equivalent of nitrogen appearance (PNA). DESIGN: Prospective, observational study. SETTING: A 74-bed intensive care unit in a single tertiary care hospital. PATIENTS: Twenty-five consecutive critically ill patients with acute renal failure on CRRT. METHODS: The patients were studied over a period of 24 hours, at initiation on CRRT. The nutritional status was assessed by anthropometry and bioimpedance analysis. The PNA was estimated using the Bergstrom equation and PNA was normalized to body weight. RESULTS: The mean age was 58.2 +/- 17 years and 20 (80%) were male. The mean weight was 67 +/- 12 kg, body mass index was 25 +/- 3.5 kg/m(2), and triceps and subscapular skin fold thickness were 13 +/- 4.6 mm and 15 +/- 2.5 mm, respectively. Bioimpedance studies showed that the total body water was increased at 61.7 +/- 5.5% and body fat was 31.8 +/- 5.4%. The PNA was 103 +/- 35 g/day and normalized PNA was 1.57 +/- 0.4 g/kg/day. The mean protein intake was 0.56 +/- 0.38 g/kg/day, resulting in mean net negative protein balance of 1.0 +/- 0.6 g/kg/day. CONCLUSIONS: Malnutrition was uncommon in patients with acute renal failure at the time of initiation on CRRT, but their total body water was increased. They exhibited hypercatabolism and the mean normalized PNA was 1.57 g/kg/day. A large negative nitrogen balance was observed in them, since their protein intake was suboptimal.
Subject(s)
Acute Kidney Injury/therapy , Body Water/metabolism , Dietary Proteins/administration & dosage , Nitrogen/metabolism , Nutritional Requirements , Nutritional Status , APACHE , Anthropometry , Blood Urea Nitrogen , Critical Care , Critical Illness/therapy , Dietary Proteins/metabolism , Electric Impedance , Energy Metabolism/physiology , Female , Hemofiltration , Humans , Male , Middle Aged , Nutrition Assessment , Prospective StudiesABSTRACT
AIM: We evaluated the performance of serum creatinine based equations to estimate glomerular filtration rate (GFR) in South Asian healthy renal donors. METHODS: GFR by 99mTc-diethylenetriamine pentaacetic acid (DTPA) renogram (mGFR) in 599 renal donors was measured. GFR was estimated using a six variable modification of diet in renal disease formula (MDRD1), a four variable MDRD formula (MDRD2), Cockcroft-Gault creatinine clearance (CG CrCl), Cockcroft-Gault glomerular filtration rate (CG GFR) and the Mayo Clinic formula (Mayo GFR). The performance of various prediction equations was compared for global bias, precision (R(2)) and accuracy (percentage of estimated GFR (eGFR) falling within 15% and 30% of mGFR). RESULTS: The mean age was 37.4 +/- 11 years and 48.2% were male. The mGFR was 95.5 +/- 11.6 mL/min per 1.73 m(2). The bias (mL/min per 1.73 m(2)) was 7.5 +/- 0.9, -9.0 +/- 0.75, 13.1 +/- 0.9, 7.5 +/- 0.9 and 23.4 +/- 0.76 for CG CrCl, CG GFR, MDRD1, MDRD2 and Mayo GFR, respectively. R(2) was 0.082 for CG CrCl and MDRD1, 0.081 for CG GFR and MDRD2 and 0.045 for Mayo GFR. The percentages of eGFR falling within 15% and 30% of mGFR were 50.5 and 80.1 for CG CrCl, 65.8 and 84 for CG GFR, 50 and 74 for MDRD1, 54.3 and 80.1 for MDRD2 and 32 and 63.4 for Mayo GFR. Overall CG GFR performed better in estimating GFR in all subjects. CONCLUSION: The CG GFR equation was better than other equations to estimate GFR in South Asian healthy renal donors. We propose a new equation derived from the regression model in our study population to estimate GFR in a South Asian healthy adult population.
Subject(s)
Creatinine/blood , Glomerular Filtration Rate , Kidney Transplantation , Living Donors , Adult , Asia , Female , Humans , Kidney/physiology , Male , Middle AgedABSTRACT
AIM: To compare natriuretic, kaliuretic, diuretic and free water clearance efficacy of continuous versus bolus intravenous furosemide administration in patients with chronic renal insufficiency. MATERIAL AND METHODS: In a prospective randomized cross-over trial, 42 patients of chronic renal insufficiency were randomized to receive the same dose of intravenous furosemide as bolus and continuous infusion. The effects of bolus and intravenous administration of furosemide on the volume of urine, sodium and potassium excretion were assessed. RESULTS: Mean age was 53.6 +/- 14 years and 23 (55%) were male. The mean modification of diet in renal disease glomerular filtration rate was 20.5 +/- 17 mL/min per 1.73 m(2). The urinary excretion of sodium in intravenous bolus and infusion was 98.1 +/- 78 and 114.4 +/- 100 mmol, respectively (P = 0.001). Total urinary volume following bolus and infusion of furosemide was 1064 +/- 627 and 1170 +/- 764 mL, respectively (0.001). The excretion of potassium was similar in bolus (15.8 +/- 16.6) and infusion (14.3 +/- 9) administration (P = 0.11). The fractional excretion of sodium was higher following infusion (16.63 +/- 16.1) than bolus administration (12.87 +/- 9) of furosemide (P = 0.016). CONCLUSION: Continuous intravenous infusion of furosemide has significantly better natriuretic and diuretic effect than bolus administration of the same dose of the drug in patients with advanced chronic renal insufficiency.
