Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jun;105(6):1559-1563.
doi: 10.3945/ajcn.116.139014. Epub 2017 May 3.

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

Affiliations

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

Andrea M New et al. Am J Clin Nutr. 2017 Jun.

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 dextrose-containing 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 ± SEM age of 61 ± 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.

Keywords: CRRT; CVVH; anticoagulation; caloric uptake; citrate; nutrition.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
A diagram of the CVVH circuit and sampling sites used for obtaining glucose and citrate concentrations. The circle with a diagonal line represents the blood flow pump. ACD-A, acid-citrate-dextrose formula A; CVVH, continuous venovenous hemofiltration; RF, replacement fluid.
FIGURE 2
FIGURE 2
Mean glucose and citrate concentrations on day 1 (n = 10).
FIGURE 3
FIGURE 3
Comparison of glucose and citrate concentrations on days 1 and 2 (n = 8).

References

    1. Ziegler TR.. Parenteral nutrition in the critically ill patient. N Engl J Med 2009;361:1088–97. - PMC - PubMed
    1. Casaer MP, Van den Berghe G.. Nutrition in the acute phase of critical illness. N Engl J Med 2014;370:1227–36. - PubMed
    1. Fraipont V, Preiser JC.. Energy estimation and measurement in critically ill patients. JPEN J Parenter Enteral Nutr 2013;37:705–13. - PubMed
    1. Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM.. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care 2014;18:701. - PMC - PubMed
    1. Beal AL, Cerra FB.. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction. JAMA 1994;271:226–33. - PubMed

Publication types

MeSH terms