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Abstract: TH-PO279

Optimal Caloric Requirements of Critically Ill Patients on Chronic Hemodialysis (CHD)

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Shehzad, Pir, UMASS Chan Med School-Baystate, Springfield, Massachusetts, United States
  • Landry, Daniel L., UMASS Chan Med School-Baystate, Springfield, Massachusetts, United States
  • Tidswell, Mark A., UMASS Chan Med School-Baystate, Springfield, Massachusetts, United States
  • Hodgins, Spencer, UMASS Chan Med School-Baystate, Springfield, Massachusetts, United States
  • Braden, Gregory Lee, UMASS Chan Med School-Baystate, Springfield, Massachusetts, United States
Background



The KDOQI 2020 nutrition guidelines do not address the energy requirements of critically ill CHD patients (pts). This study determined the actual caloric needs of critically ill CHD pts.

Methods

This was a single-center, single-blinded, randomized control trial of 11 critically ill intubated pts admitted to the ICU. A Puritan Bennet Indirect calorimeter was used for the data collection on nondialysis days or before starting hemodialysis while NPO or on enteral feeding or TPN matched for protein, fat & carbohydrates after reaching a steady state. All pts were randomized to either a 28 kcal/kg/day or a 38 kcal/kg/day after baseline NPO data was obtained the prior day. The data collected by the calorimeter were 8 hr machine averages and included VO2, VCO2, respiratory quotient, and energy expenditure. In addition, time-averaged glucose obtained every 4 hours was calculated. Finally, statistics were performed utilizing the Student’s T-test & ANOVA for paired data.

Results



A total of 11 pts were included, seven males & four females. The pts had a mean age of 39 ± 7 years. 8 out of the 11 patients completed all three days of the study. Four patients were under 60 years, two males and two females. two females and five males comprised the over-60 age group. The baseline REE for patients <60 years was 26.0 ± 4 kcal/kg/day, and for patients >60 years was 22.0 ± 2 kcal/kg/day despite sepsis in two patients in each group. REE for all NPO patients was 23.5 ± 4 kcal/kg/day and only 24.5 ± 4 kcal/kg/day, and 26.0 ± 3 kcal/kg/day for TPN days with 28 or 38 kcal/kg/day (p>0.05). Time-averaged glucose increased to a clinically significant level with both diets; 162 ± 30 mg/dL (p<0.05) for pts receiving a 28 kcal/kg/day diet and 159 ± 25 mg/dL(p<0.05) for a 38 kcal/kg/day diet.(Table1)

Conclusion

Current KDOQI nutrition recommendations overestimate the energy expenditure of critically ill HD patients. Critically ill CHD pts should be fed 24-26 kcal/kg/day or have their EE measured by indirect calorimetry to receive proper nutrition and avoid overfeeding.

Funding

  • Clinical Revenue Support