IS PARENTERAL-NUTRITION THERAPY OF VALUE IN ACUTE-RENAL-FAILURE PATIENTS

A patient with oliguric acute renal failure (ARF) following mitral val ve surgery is presented, The patient was treated with parenteral nutri tion and hemodialysis. While the patient survived, there were several complications of nutrition therapy, In this review, the benefits, risk s, and uncertainties regarding parenteral nutrition in ARF are conside red. First, the differences in metabolism in complicated and uncomplic ated acute uremia are discussed, The important roles of alterations in intermediary metabolism and of proteases in the catabolism of ARF are emphasized, The historical basis of parenteral nutrition treatment in ARF is reviewed, The results are divided regarding the relationship a mong nutritional support, improvement in renal function, and enhanced patient survival, A critical analysis of nitrogen metabolism results r eported in the literature does not convincingly support the effectiven ess of parenteral nutrition formulae in generating positive nitrogen b alance, The complications of parenteral nutrition therapy are outlined , In light of the uncertain efficacy and recognized risks of prolonged parenteral nutrition, a rationale for approaching therapy is presente d that is based on the estimated metabolic stress and protein-energy r equirements of the individual ARF patient. (C) 1995 by the National Ki dney Foundation, Inc.