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Practice Guideline
. 2024 Sep;43(9):2238-2254.
doi: 10.1016/j.clnu.2024.08.002. Epub 2024 Aug 20.

ESPEN practical guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease

Alice Sabatino  1 , Enrico Fiaccadori  2 , Rocco Barazzoni  3 , Juan Jesus Carrero  4 , Adamasco Cupisti  5 , Elisabeth De Waele  6 , Joop Jonckheer  7 , Cristina Cuerda  8 , Stephan C Bischoff  9
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Free article
Practice Guideline

ESPEN practical guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease

Alice Sabatino et al. Clin Nutr. 2024 Sep.
Free article

Erratum in

Abstract

Background and aims: Hospitalized patients often have acute kidney disease (AKD) or chronic kidney disease (CKD), with important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, the possible impact on nutritional requirements cannot be neglected. On this regard, the present guideline aims to provide evidence-based recommendations for clinical nutrition in hospitalized patients with KD.

Methods: The standard operating procedure for ESPEN guidelines was used. Clinical questions were defined in both the PICO format, and organized in subtopics when needed, and in non-PICO questions for the more general topics. The literature search was from January 1st, 1999 until January 1st, 2020. Each question led to one or more recommendation/statement and related commentaries. Existing evidence was graded, as well as recommendations and statements were developed and agreed upon in a multistage consensus process.

Results: The present guideline provides 32 evidence-based recommendations and 8 statements, defining how to assess nutritional status, how to define patients at risk, how to choose the route of feeding, and how to integrate nutrition with KRT. In the final online voting, a strong consensus was reached in 84% at least of recommendations and 100% of statements.

Conclusion: The presence of KD in hospitalized patients identifies a highly heterogeneous group of subjects with widely varying nutrient needs and intakes. Considering the high nutritional risk related with this clinical condition, an individualized approach consisting of nutritional status evaluation and monitoring, frequent evaluation of nutritional requirements, and careful integration with KRT should be planned to avoid both underfeeding and overfeeding. Practical recommendations and statements were developed, aiming at defining suggestions for everyday clinical practice in the individualization of nutritional support in this patient setting. Literature areas with scarce or without evidence were also identified, thus requiring further basic or clinical research.

Keywords: Hospitalized patients; Intensive care unit; Kidney disease; Kidney replacement therapy; Malnutrition; Medical Nutrition Therapy.

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Conflict of interest statement

Conflict of interest The expert members of the working group were accredited by the ESPEN Guidelines Group, the ESPEN Education and Clinical Practice Committee, and the ESPEN executive. All expert members have declared their individual conflicts of interest according to the rules of the International Committee of Medical Journal Editors (ICMJE). If potential conflicts were indicated, they were reviewed by the ESPEN guideline officers and, in cases of doubts, by the ESPEN executive. None of the expert panel had to be excluded from the working group or from co-authorship because of serious conflicts. The conflict of interest forms are stored at the ESPEN guideline office and can be reviewed with legitimate interest upon request to the ESPEN executive.

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