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Nutrition Support Blog: Spring Research Update

Posted by SF8N at Jun 05, 2015 10:15 AM |
June 5, 2015
Nutrition Support Blog: Spring Research Update

by Joe Krenitsky, MS, RD

I am long overdue for a blog update, in part because I was summarizing the research highlights of the past year for a webinar.  Now that the data from last year has been discussed, I wanted to share some “hot off the presses” research.

The first is a randomized study of increased protein provision in acute kidney injury in adult ICU patients:

Doig GS, Simpson F, Bellomo R, et al.  Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial. Intensive Care Med. 2015 Apr 30. [Epub ahead of print]

The investigators randomized 474 ICU patients to receive standard nutrition care compared to standard care with additional parenteral amino acids to bring total protein to a goal of 2 grams/Kg.  The study found that increased protein appeared to improve the glomerular filtration rate of patients with AKI, but did not shorten the duration of renal dysfunction.  Serum urea was statistically increased in the high protein group (mean of 42±26 mg/dl) compared with the standard nutrition (mean of 30.5 ±17.6 mg/dl), but it does not appear that this was a clinically significant difference. One aspect of this study that is worthwhile for further scrutiny and discussion is the fact that increasing protein in these patients did not seem to improve any of the other clinical endpoints either.  Considering that there is so minimal data about the best protein intake of critically ill adults, this paper may be a valuable addition to what we know.

***

The second study that I wanted to share was on another of my favorite topics – hypocaloric feeding in the ICU:

Arabi YM, Aldawood AS, Haddad SH, et al.  Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults.  N Engl J Med. 2015 May 20. [Epub ahead of print]

This study randomized 894 critically ill adults to receive either hypocaloric feeding (40-60% of calorie expenditure), or full calories, with similar protein between the groups.  There was no significant difference in mortality or other major outcomes between the 2 groups.

I have to admit that I was a little disappointed that neither of these studies showed any paradigm-changing benefits, but as always, knowing the truth is better than not knowing anything.  Of course, there are a number of important details about these studies that need to be considered, and they are so new that we have not even had a chance yet to complete our full evaluation yet.  Stay tuned and check out our e-journal club in the near future, because we will be talking about the hypocaloric feeding study in 2 weeks.  If you have any thoughts or insights on these studies, please send them along to me (so I can seem especially wise at journal club :)

 

"If we knew what it was we were doing, it would not be called research, would it?"                       Albert Einstein

 

“New knowledge is the most valuable commodity on earth.  The more truth we have to work with, the richer we become.”

                        Kurt Vonnegut Jr., Cat’s Cradle, 1963

 

 

 

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