Calorie intake and patient outcomes in severe acute kidney injury: findings from the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial
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(Published version)
Date
2014
Authors
Bellomo, R.
Cass, A.
Cole, L.
Finfer, S.
Gallagher, M.
Lee, J.
Lo, S.
McArthur, C.
McGuinness, S.
Myburgh, J.
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Journal article
Citation
Critical Care, 2014; 18(2):R45-1-R45-11
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Rinaldo Bellomo, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Joanne Lee, Serigne Lo, Colin McArthur, Shay McGuinness, John Myburgh, Robyn Norton, Carlos Scheinkestel, and The RENAL Study Investigators
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Abstract
INTRODUCTION: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes. METHODS: We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models. RESULTS: Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling. CONCLUSIONS: In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00221013.
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RENAL Study Investigators: Athanasios Flabouris for the University of Adelaide.
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© 2014 Bellomo et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.