ACUTE-RENAL-FAILURE - NUTRITIONAL DISORDE RS AND THERAPEUTIC IMPLICATIONS

Catabolism is usually enhanced in acute renal failure (ARF). Its magni tude varies from one patient to another and can change significantly i n the same patient from day to day, reflecting its clinical course. It depends on the severity of the ARF, the underlying process, the assoc iated co-morbidity, and therapeutic approach. The detection of patient s at high risk for malnutrition is extremely important; nutritional ma rkers and indexes of caloric and protein requirements are useful to ad apt renal replacement and nutritional support to ARF patients. Various biochemical parameters (namely, serum albumin and prealbumin), anthro pometric measures, indirect calorimetry, urea and creatinine kinetics are all useful tools to evaluate metabolic status and requirements nut ritionnal. Commonly, the caloric requirements are nearly 35 kcal/kg/24 h with correction factors applied for certain clinical situations; car bohydrates account for 50 to 60% of those needs whereas lipids account for the rest. The total amount of fluid administered has to be adapte d to the possible ultrafiltration achieved by dialysis. Daily dialysis sessions and continuous renal replacement therapy allow larger volume s and thus facilitate nutritional support. Protein needs frequently ex ceed 1,2 g/kg/24 h to maintain the nitrogen balance, with a calorie to protein ration close to 150 kcal per g of nitrogen. Sufficient amount s of vitamins and oligoelements are necessary. Stimulating anabolism b y exogenous mediators, such as androgenic hormones or growth factors ( rh-IGF1, rh-GH) is an avenue that deserves better definition in critic ally ill ARF patients.