Kidney Week

Abstract: TH-PO0744

Effect of Protein Intake on Mortality and Clinical Outcomes in Critically Ill Adults with AKI Requiring Kidney Replacement Therapy: A Meta-Analysis

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Sultana, Syeda Salima, New York City Health and Hospitals South Brooklyn Health, New York, New York, United States

Syeda Salima Sultana, MD

• Islam, Nayeemul, Sir Salimullah Medical College, Dhaka, Dhaka Division, Bangladesh

Nayeemul Islam

• Haque, Tahmina, Comilla Medical College, Cumilla, Chittagong Division, Bangladesh

Tahmina Haque, MBBS

• Ahsan, Sayed Shehtab, Dhaka Medical College and Hospital, Dhaka, Dhaka Division, Bangladesh

Sayed Shehtab Ahsan, MBBS

• Abd El Meguid, Hana, New York City Health and Hospitals South Brooklyn Health, New York, New York, United States

Hana Abd El Meguid, MD

• Naurin, Sadia Afrin, Ibrahim Medical College, Dhaka, Dhaka Division, Bangladesh

Sadia Afrin Naurin, MBBS

• Roy, Arthi, Pabna Medical College, Pabna, Rajshahi Division, Bangladesh

Arthi Roy

• Shah-Riar, Prince, DHR Health, Edinburg, Texas, United States

Prince Shah-Riar, MD

• Kadurei, Firas, New York City Health and Hospitals South Brooklyn Health, New York, New York, United States

Firas Kadurei, MBBS

• Lee, Winston, New York City Health and Hospitals South Brooklyn Health, New York, New York, United States

Winston Lee, MD

Background

Critically ill patients with acute kidney injury (AKI) requiring kidney replacement therapy (KRT) are at increased risk of malnutrition due to catabolic stress and nutrient losses during dialysis. Poor nutritional status in critically ill AKI patients on KRT is linked to increased mortality and prolonged ICU stays. While enteral nutrition (EN) is standard, the optimal protein dose remains controversial. Higher intake may offset metabolic losses, but its impact on clinical outcomes is not yet established. As such, this study aimed to compare high-protein versus standard-protein enteral nutrition and their association with mortality and other clinical outcomes in critically ill adults with AKI receiving KRT.

Methods

Following PRISMA guidelines, we searched six databases (PubMed, Cochrane CENTRAL, PLoS, Google Scholar, ScienceDirect). A total of 293 articles were initially retrieved; yielding 35 records for full-text assessment, of which 5 studies met final inclusion criteria. Eligible studies included RCTs and observational studies enrolling critically ill adults (≥18 years) with AKI receiving any modality of KRT and comparing high-protein versus standard-protein enteral nutrition. Risk of bias was assessed using Cochrane RoB 1. Meta-analyses were performed using RevMan 5 with random-effects models.

Results

Five studies with low risk of bias were included. High-protein EN was associated with significantly lower ICU mortality (RR 0.73, 95% CI 0.58-0.93) and all-cause mortality at 28 days (RR 0.74, 95% CI 0.61-0.89) compared to standard protein.Hospital mortality, 90-day mortality, ICU/hospital length of stay (LOS) and duration of mechanical ventilation did not differ significantly between groups.High-protein EN was associated with greater caloric delivery (SMD 0.90, 95% CI 0.22-1.58; I2=97%), though protein delivery showed no significant difference across groups (SMD 1.50, 95% CI -1.90-4.90; I2=100%).

Conclusion

In critically ill AKI patients on KRT, high-protein EN significantly reduced ICU and 28-day mortality compared to standard-protein EN. However, no differences were found in long-term mortality, LOS, or mechanical ventilation duration. High-protein EN may improve short-term survival; however, substantial heterogeneity necessitates cautious interpretation. Further large-scale RCTs are required to determine optimal dosing