Renal Failure

Although increased protein load increases blood urea concentrations in acute renal failure and leads to dialysis, adequate protein administration is necessary for the injured kidney to heal. Modern critical care practice is to provide normal protein administration with standard formulas and use dialysis as necessary to control urea, creatinine, electrolytes, and plasma volume.

Continuous Renal Replacement Therapies

Continuous renal replacement therapies (CRRTs) are associated with a spectrum of metabolic abnormalities that result from blood detoxification. The continuous nature of the procedure is characterized by a high fluid turnover resulting in potential complications associated with CRRT. Small-molecular-weight compounds such as amino acids or water-soluble vitamins can be lost. Although the synthetic membranes used to filter have a beneficial effect of removing complement and endotoxin, bioincompatibility may result in a low-grade inflammatory response with adverse effects on the host. In designing a nutritional regimen for these patients, the physician must consider the loss of nutrients and the adverse effects of glucose or lactate added to the substitution or dialysate fluid.