Continuous renal replacement therapy: A potential source of calories in the critically ill

Andrea M. New, Erin M. Nystrom, Erin Frazee, John J. Dillon, Kianoush B. Kashani, John M. Miles

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: Overfeeding can lead to multiple metabolic and clinical complications and has been associated with increased mortality in the critically ill. Continuous venovenous hemofiltration (CVVH) represents a potential source of calories that is poorly recognized and may contribute to overfeeding complications. Objective: We aimed to quantify the systemic caloric contribution of acid-citrate-dextrose regional anticoagulation and dextrosecontaining replacement fluids in the CVVH circuit. Design: This was a prospective study in 10 critically ill adult patients who received CVVH from April 2014 to June 2014. Serial pre-and postfilter blood samples (n = 4 each) were drawn and analyzed for glucose and citrate concentrations on each of 2 consecutive days. Results: Participants included 5 men and 5 women with a mean 6 SEM age of 61 6 4 y (range: 42-84 y) and body mass index (in kg/m2) of 28 ± 2 (range: 18.3-36.2). There was generally good agreement between data on the 2 study days (CV: 7-11%). Mean ± SEM pre-and postfilter venous plasma glucose concentrations in the aggregate group were 152 ± 10 and 178 ± 9 mg/dL, respectively. Net glucose uptake from the CVVH circuit was 54 ± 5 mg/min and provided 295 ± 28 kcal/d. Prefilter plasma glucose concentrations were higher in patients with diabetes (n = 5) than in those without diabetes (168 ± 12 compared with 140 ± 14 mg/dL; P < 0.05); however, net glucose uptake was similar (46 ± 8 compared with 61 ± 6 mg/min; P = 0.15). Mean ± SEM pre-and postfilter venous plasma citrate concentrations were 1 ± 0.1 and 3.1 ± 0.2 mmol/L, respectively. Net citrate uptake from the CVVH circuit was 60 ± 2 mg/min and provided 218 ± 8 kcal/d. Conclusions: During CVVH there was a substantial net uptake of both glucose and citrate that delivered exogenous energy and provided ∼512 kcal/d. Failure to account for this source of calories in critically ill patients receiving nutrition on CVVH may result in overfeeding. Am J Clin Nutr 2017;105:1559-63.

Original languageEnglish (US)
Pages (from-to)1559-1563
Number of pages5
JournalAmerican Journal of Clinical Nutrition
Volume105
Issue number6
DOIs
StatePublished - Jun 1 2017

Keywords

  • Anticoagulation
  • CRRT
  • CVVH
  • Caloric uptake
  • Citrate
  • Nutrition

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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    New, A. M., Nystrom, E. M., Frazee, E., Dillon, J. J., Kashani, K. B., & Miles, J. M. (2017). Continuous renal replacement therapy: A potential source of calories in the critically ill. American Journal of Clinical Nutrition, 105(6), 1559-1563. https://doi.org/10.3945/ajcn.116.139014