Abstract: TH-PO821
KDOQI Nutrition Guideline 21 Associates with Overfeeding in Critically Ill ESRD Patients
Session Information
- Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular
Authors
- McKenna-Weiss, Eli, U Mass Medical School/Baystate, Springfield, Massachusetts, United States
- Landry, Daniel L., U Mass Medical School/Baystate, Springfield, Massachusetts, United States
- Mailloux, Patrick, U Mass Medical School/Baystate, Springfield, Massachusetts, United States
- Kim, Young hee, U Mass Medical School/Baystate, Springfield, Massachusetts, United States
- Braden, Gregory Lee, U Mass Medical School/Baystate, Springfield, Massachusetts, United States
Background
KDOQI nutrition guideline 21 states that critically ill ESRD patients(pts) less than 60 yr old receive at least 35 kcal/kg/day of total parenteral nutrition(TPN) & pts over 60 should receive 30-35 kcal/kg/day TPN. U.S. guidelines for ICU nutrition suggest 22-24 kcal/kg/d for critically ill non ESRD pts.
Methods
We studied 11 intubated ESRD pts (4W/7M) in the ICU with the Puritan Bennett indirect calorimeter on 3 different non dialysis days while NPO and during TPN with 28 or 38 kcal/kg/d. 4 pts were under age 60 & 7 pts were over age 60. Only 1 pt had diabetes mellitus. Causes for the ICU: sepsis 4, respiratory failure 5, cva 1 & chf 1. Mean time on hemodialysis was 1.5 years and mean serum albumin pre study was only 2.4+/- 0.2 gm/dl. Pts were studied from 5 am to 1 pm & the results of resting energy expenditure (REE), VO2 (ml/min), VCO2 (ml/min) and respiratory quotient(RQ) were calculated by the continuous machine averages for all parameters. Time averaged glucose levels q 4 hours were calculated. TPN intake ratios for both the 28 and 38 kcal studies were: 20% protein, 30% fat & 50% carbohydrates.
Results
Baseline REE for age under 60 was 26.0 +/- 4 kcal/kg/d and for over 60 was 22.0 +/- 2 kcal/kg/d despite sepsis in 2 pts in each group (p NS). REE for all NPO pts was only 23.5 +/- 4 kcal/kg/d & only 24.5 +/- 4 & 26.0 +/- 3 for TPN days with 28 or 38 kcal/kg/d (p NS).The mean +/- SE for indirect calorimetry are shown in the table:
Conclusion
We conclude: 1) The REE in critically ill ESRD pts is similar to non ESRD pts with a mean REE of 23.5 kcal/kg/d. 2) There are no differences in REE in ESRD pts less than or over age 60. 3) Early feeding TPN in ICU ESRD pts at 28 or 38 ckal/kg/d signicantly increaed VO2, VCO2, RQ and glucose levels which indicates excessive carbohydrate metabolism &/or increased lipogenesis which may be harmful to these pts. 4) KDOQI nutrition guideline 21 needs to be modified based on our study.
| VO2 (ml/min) | VCO2 (ml/min) | RQ | Glucose | |
| NPO | 208+/- 19 | 166 +/- 12 | 0.80 | 106 +/- 15 |
| 28 Kcal/kg | 204 +/- 20 | 192 +/- 13# | 0.95# | 162 +/- 30# |
| 38 Kcal/kg | 239 +/- 32# | 214 +/- 24# | 0.95# | 159 +/- 25# |
# p < 0.05 compared to NPO. The increased VCO2, RQ & glucose levels suggest carbohydrate overfeeding and increased lipogenesis in the TPN groups. No differences found between 28 and 38 kcal groups in any parameter.