Impact of increasing parenteral protein loads on @entity535 levels and balance in critically ill anuric XXXX on continuous renal replacement therapy.

@entity1 @entity1522 @entity1568 @entity535 @entity1131 @entity1674 @entity7540 @entity204 @entity21931 @entity413
OBJECTIVES: We wanted to establish optimum protein and @entity413 intakes during total parenteral nutrition by using a constant caloric but changing @entity1131 in critically ill, ventilated, anuric @entity1 on continuous renal replacement therapy and measuring @entity535 and @entity413 losses across the hemofilter. METHODS: Eleven consecutive, critically ill @entity1 (eight male, age, 43.5 +/- 21.8 y; Acute Physiology and Chronic Health Evaluation II score, 20.5 +/- 7.0; Acute Physiology and Chronic Health Evaluation risk of @entity204 : 36.5% +/- 23.0 and 6 +/- 1 impaired organ systems) entered this study. @entity1 were fed by continuous infusion of a total parenteral mixture consisting of @entity21931 (a mixture of essential and non-essential @entity1522 ), 50% @entity413 , and intralipid (long-chain @entity1674 ) to meet caloric requirements as predicted by Schofield's equation corrected by stress factors. The amount of protein infused was varied (1 to 2.5 g. kg(-1). d(-1)) by increments of 0.25 g. kg(-1). d(-1). @entity1 were stabilized on each feeding regimen for at least 24 h before paired samples of blood and dialysate were taken for @entity535 and @entity413 measurements. Continuous renal replacement therapy was performed by using a blood pump with a blood flow of 100 to 175 mL/min. Dialysate was pumped in and out counter-currently to the blood flow at 2 L/h. A biocompatible @entity7540 hemofilter was used in all cases. RESULTS: With protein intakes below 2.5 g. kg(-1). d(-1), blood levels of 14% to 57% of the measured @entity1522 were below the lower limits of the normal range. At 2.5 g. kg(-1). d(-1), all measured @entity1522 were within the normal range. @entity535 balance became more positive as protein input increased (P = 0.0001). @entity413 and @entity535 losses were dependent on blood concentration. Overall, 17% (range, 13% to 24%) of infused @entity1522 and 4% of infused @entity413 were lost in the dialysate. CONCLUSIONS: This study of critically ill, ventilated, anuric @entity1 on continuous renal replacement therapy suggested that increases in protein and @entity413 are required to account for the increased losses across the hemofilter. A @entity1131 of 2.5 g. kg(-1). d(-1) appeared to optimize @entity1568 balance and correct @entity535 deficiencies.
