Calorie intake and patient outcomes in severe acute kidney injury: Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial

Bellomo, Rinaldo, Cass, Alan, Cole, Louise, Finfer, Simon, Gallagher, Martin, Lee, Janne, Lo, Serigne, McArthur, Colin, McGuinness, Shay, Myburgh, John, Norton, Robyn, Scheinkestel, Carlos, The RENAL Study Investigators, Lipman, Jeffrey and Boots, Robert (2014) Calorie intake and patient outcomes in severe acute kidney injury: Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial. Critical Care, 18 2: 1-11. doi:10.1186/cc13767


Author Bellomo, Rinaldo
Cass, Alan
Cole, Louise
Finfer, Simon
Gallagher, Martin
Lee, Janne
Lo, Serigne
McArthur, Colin
McGuinness, Shay
Myburgh, John
Norton, Robyn
Scheinkestel, Carlos
The RENAL Study Investigators
Lipman, Jeffrey
Boots, Robert
Title Calorie intake and patient outcomes in severe acute kidney injury: Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
1364-8535
Publication date 2014-03-14
Sub-type Article (original research)
DOI 10.1186/cc13767
Open Access Status DOI
Volume 18
Issue 2
Start page 1
End page 11
Total pages 11
Place of publication London, Engand, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Formatted abstract
Introduction
Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes.

Methods
We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models.

Results
Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling.

Conclusions
In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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Created: Wed, 01 Apr 2015, 21:25:51 EST by Matthew Lamb on behalf of School of Medicine