Acute renal failure

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The implementation of continuous renal replacement therapy in the intensive care unit setting has drastically reduced the requirement for a different nutritional approach compared with other critically ill patients. The estimated energy production rate could be increased if warming equipment is not available. It is easy to calculate the heat loss if the body and fluid temperatures and the volume of daily replacement fluids are known. Fat substrate (both long- and medium-chain) should be administered with caution because of reduced disposal; carbohydrates (with or without insulin supplementation) appear to be tolerated better.

Body nitrogen losses are assessed by measuring urea nitrogen plus dialysate urea and amino acid losses (5-15 g/day). A general amino acid solution is generally indicated for replacement, despite the reported particular need for histidine, arginine, taurine, and tyrosine. Folinic acid (1 mg) and vitamin C (500 mg) supplementation during hemofiltration is suggested, with no variation in trace elements and other vitamins.

Enteral nutrition should be used whenever possible.

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