Индивидуальный подход к назначению искусственного питания у больных с острым почечным повреждением в критическом состоянии


М.Е. Ильинский, Ю.Н. Лященко, С.И. Рей, С.С. Петриков

ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»; Москва, Россия
На основании современных возможностей оценки статуса питания, индивидуальных особенностей метаболизма и изменений, обусловленных применением заместительной почечной терапии пациентов с острым почечным повреждением, находящихся в критическом состоянии, предложен алгоритм дифференцированного подхода к назначению искусственного питания.

Литература


  1. Zhang J.H., O’Connor T.Z., Chertow G.M., Crowley S.T., Choudhury D., et al. Intensity of renal support in critically ill patients with acute kidney injury. N. Engl. J. Med. 2008;359(1):7–20. Doi: http://dx.doi.org/10.1056/NEJMoa0802639.
  2. Susantitaphong P., Cruz D.N., Cerda J., Abulfaraj M., Alqahtani F., Koulouridis I., Jaber B.L. Acute Kidney Injury Advisory Group of the American Society of Nephrology. World incidence of AKI: a meta-analysis. Clin. J. Am. Soc. Nephrol. 2013;8(9):1482–1493. Doi: http://dx.doi.org/10.2215/CJN.00710113.
  3. Fouque D., Kalantar-Zadeh K., Kopple J., Cano N., et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391–398. Doi: http://dx.doi.org/10.1038/sj.ki.5002585.
  4. Fiaccadori E., Lombardi M., Leonardi S., Rotelli C.F., Tortorella G., Borghetti A. Prevalence and clinical outcome associated with preexisting malnutrition in acute renal failure: a prospective cohort study. J. Am. Soc. Nephrol. 1999;10(3):581–593.
  5. Basi S., Pupim L.B., Simmons E.M., Sezer M.T., Shyr Y., Freedman S., Chertow G.M., Mehta R.L., Paganini E., Himmelfarb J., Ikizler T.A. Insulin resistance in critically ill patients with acute renal failure. Am. J. Physiol. Renal. Physiol. 2005;289(2):F259–264. Doi: http://dx.doi.org/10.1152/ajprenal.00002.2005.
  6. Cianciaruso B., Bellizzi V., Napoli R., Saccá L., Kopple J.D. Hepatic uptake and release of glucose, lactate, and amino acids in acutely uremic dogs. Metabolism. 1991;40(3):261–269. Doi: http://dx.doi.org/10.1016/0026-0495(91)90107-8.
  7. Schetz M., Vanhorebeek I., Wouters P.J., Wilmer A., Van den Berghe G. Tight Blood Glucose Control Is Renoprotective in Critically ill Patients. J. Am. Soc. Nephrol. 2008;19(3):571–578. Doi: http://dx.doi.org/10.1681/ASN.2006101091.
  8. KDIGO Clinical practice guidelines for acute kidney injury. Chapter 3.2. General supportive management of patients with AKI, including management of complications. Kidney Int. Suppl. 2012;2:37–68. Doi: http://dx.doi.org/10.1038/kisup.2011.33.
  9. Krinsley J.S., Egi M., Kiss A., Devendra A.N., et al. Diabetic status and the relationship of the 3 domains of glycemic control to mortality in critically ill patients: an international multi-center cohort study. Crit. Care. 2013;17(2):R37. Doi: http://dx.doi.org/10.1186/cc12547.
  10. Sechterberger M.K., Bosman R.J., Oudemans-van Straaten H.M., Siegelaar S.E., et al. The effect of diabetes mellitus on the association between measures of glycemic control and intensive care mortality: a retrospective cohort study. Crit. Care. 2013;17(2): R52. Doi: http://dx.doi.org/10.1186/cc12572.
  11. Rhodes A., Evans L.E., Alhazzani W., Levy M.M., Antonelli M., et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive. Care Med. 201743(3):304–377. Doi: http://dx.doi.org/10.1007/s00134-017-4683-6.
  12. Druml W., Zechner R., Magometschnigg D., Lenz K., Kleinberger G., Laggner A., Kostner G. Post-heparin lipolytic activity in acute renal failure. Clin. Nephrol. 1985;23(6): 289–293.
  13. Fiaccadori E., Regolisti G., Cabassi A. Specific nutritional problems in acute kidney injury, treated with non-dialysis and dialytic modalities. NDT Plus. 2010;3(1):1–7. Doi: http://dx.doi.org/10.1093/ndtplus/sfp017.
  14. Druml W. Nutritional management of acute renal failure. J. Ren. Nutr. 2005;15(1):63–70. Doi: http://dx.doi.org/10.1053/j.jrn.2004.09.012.
  15. Fiaccadori E., Maggiore U., Rotelli C., Giacosa R., et al. Effects of different energy intakes on nitrogen balance in patients with acute renal failure: a pilot study. Nephrol. Dial. Transplant. 2005;20(9):1976–1980. Doi: http://dx.doi.org/10.1093/ndt/gfh956.
  16. Bear D.E., Parry S.M., Puthucheary Z. A. Can the critically ill patient generate sufficient energy to facilitate exercise in the ICU? Curr. Opin. Clin. Nutr. Metab. Care. 2017;20(2):110–150. Doi: http://dx.doi.org/10.1097/MCO.0000000000000446.
  17. Pupim L.B., Flakoll P.J., Levenhagen D.K., Ikizler T.A. Exercise augments the acute anabolic effects of intradialytic parenteral nutrition in chronic hemodialysis patients. Am. J. Physiol. Endocrinol. Metab. 2004;286(4):E589–597. Doi: http://dx.doi.org/10.1152/ajpendo.00384.2003.
  18. Heyland D.K., Stapleton R.D., Mourtzakis M., Hough C.L., Morris P., Deutz N.E., Colantuoni E., Day A., Prado C.M., Needham D.M. Combining nutrition and exercise to optimize survival and recovery from critical illness: conceptual and methodological issues. Clin. Nutr. 2016;35(5):1196–1206. Doi: http://dx.doi.org/10.1016/j.clnu.2015.07.003.
  19. Kondrup J., Rasmussen H.H., Hamberg O., Stanga Z.; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin. Nutr. 2003;22(3):321–336. Doi: http://dx.doi.org/10.1016/S0261-5614(02)00214-5.
  20. Heyland D.K., Dhaliwal R., Jiang X., Day A.G. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit. Care. 201115(6):R268. Doi: http://dx.doi.org/10.1186/cc10546.
  21. Shen W., Punyanitya M., Wang Z., Gallagher D., St-Onge M.P., Albu J., Heymsfield S.B., Heshka S. Visceral adipose tissue: relations between single-slice areas and total volume. Am. J. Clin. Nutr. 2004;80(2):271–278. Doi: http://dx.doi.org/10.1093/ajcn/80.2.271.
  22. Fischer A., Spiegl M., Altmann K., Winkler A., et al. Muscle mass, strength and functional outcomes in critically ill patients after cardiothoracic surgery: does neuromuscular electrical stimulation help? The Catastim 2 randomized controlled trial. Crit. Care. 2016;20:30. Doi: http://dx.doi.org/10.1186/s13054-016-1199-3.
  23. Maioli M., Toso A., Leoncini M., Musilli N., Bellandi F., Rosner M.H., McCullough P.A., Ronco C. Pre-procedural bioimpedance vectorial analysis of fluid status and prediction of contrast-induced acute kidney injury. J. Am. Coll. Cardiol. 2014;63(14):1387–1394. Doi: http://dx.doi.org/10.1016/j.jacc.2014.01.025.
  24. Cano N., Fiaccadori E., Tesinsky P., Toigo G., Druml W., Kuhlmann M., Mann H., Hörl W.H. ESPEN guidelines on enteral nutrition: Adult renal failure. Clin. Nutr. 2006;25(2):295–310. Doi: http://dx.doi.org/10.1016/j.clnu.2006.01.023.
  25. Cano N., Aparicio M., Brunori G., Carrero J.J., Cianciaruso B., Fiaccadori E., Lindholm B., Teplan V., Fouque D., Guarnieri G. ESPEN guidelines on parenteral nutrition: Adult renal failure. Clin. Nutr. 2009;28(4):401–414. Doi: http://dx.doi.org/10.1016/j.clnu.2009.05.016.
  26. McClave S.A., Taylor B.E., Martindale R.G., Warren M.M., et al. Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J. Parenter. Enteral. Nutr. 2016;40:159–211. Doi: http://dx.doi.org/10.1177/0148607115621863.
  27. Bellomo R., Tan H.K., Bhonagiri S., Gopal I., Seacombe J., Daskalakis M., Boyce N. High protein intake during continuous hemodiafiltration: impact on amino acids and nitrogen balance. Int. J. Artif. Organs. 2002;25 (4):261–268.
  28. Bellomo R., Cass A., Cole L., Finfer S., et al. RENAL Study Investigators. Daily protein intake and patient outcomes in severe acute kidney injury: findings of the randomized evaluation of normal versus augmented level of replacement therapy (RENAL) trial. Blood Purif. 2014;37(4):325–334. Doi: http://dx.doi.org/10.1159/000363175.
  29. Bellomo R., Cass A., Cole L., Finfer S., et al. 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. Crit. Care. 2014;18(2):R45. Doi: http://dx.doi.org/10.1186/cc13767.
  30. Kreymann G., DeLegge M.H., Luft G., Hise M.E., Zaloga G.P. The ratio of energy expenditure to nitrogen loss in diverse patient groups--a systematic review. Clin. Nutr. 2012;31(2):168–175. Doi: http://dx.doi.org/10.1016/j.clnu.2011.12.004.
  31. Oshima T., Berger M.M., De Waele E., Guttormsen A.B., Heidegger C.P., Hiesmayr M., Singer P., Wernerman J., Pichard C. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clin. Nutr. 2017;36(3):651–662. Doi: http://dx.doi.org/10.1016/j.clnu.2016.06.010.
  32. Preiser J.C., van Zanten A.R., Berger M.M., Biolo G., et al.Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit. Care. 2015;19:35. Doi: http://dx.doi.org/10.1186/s13054-015-0737-8.
  33. Faisy C., Guerot E., Diehl J.L., Labrousse J., Fagon J.Y. Assessment of resting energy expenditure in mechanically ventilated patients. Am. J. Clin. Nutr. 2003;78(2):241–249. Doi: http://dx.doi.org/10.1093 /ajcn /78.2.241.
  34. Sabatino A., Theilla M., Hellerman M., Singer P., Maggiore U., Barbagallo M., Regolisti G., Fiaccadori E. Energy and Protein in Critically Ill Patients with AKI: A Prospective, Multicenter Observational Study Using Indirect Calorimetry and Protein Catabolic Rate. Nutrients. 2017;9(8):802. pii: E802. Doi: http://dx.doi.org/10.3390/nu9080802.
  35. De Waele E., van Zwam K., Mattens S., Staessens K., Diltoer M., Honoré P.M., Czapla J., Nijs J., La Meir M., Huyghens L., Spapen H. Measuring resting energy expenditure during extracorporeal membrane oxygenation: preliminary clinical experience with a proposed theoretical model. Acta Anaesthesiol. Scand. 2015;59(10):1296–1302. Doi: http://dx.doi.org/10.1111/aas.12564.
  36. Calloway D.H., Odell A.C., Margen S. Sweat and miscellaneous nitrogen losses in human balance studies. J. Nutr. 1971;101(6):775–786. http://dx.doi.org/10.1093/jn/101.6.775.
  37. Btaiche I.F., Mohammad R.A., Alaniz C., Mueller B.A. Amino acid requirements in critically ill patients with acute kidney injury treated with continuous renal replacement therapy. Pharmacotherapy. 2008;28(5):600–613. Doi: http://dx.doi.org/10.1592/phco.28.5.600.
  38. Konstantinides F.N., Konstantinides N.N., Li J.C., Myaya M.E., Cerra F.B. Urinary urea nitrogen: too insensitive for calculating nitrogen balance studies in surgical clinical nutrition. JPEN J. Parenter. Enteral. Nutr. 1991;15(2):189–193. Doi: http://dx.doi.org/10.1177/0148607191015002189.
  39. Gervasio J.M., Garmon W.P., Holowaty M. Nutrition support in acute kidney injury. Nutr. Clin. Pract. 2011;26(4):374–380. Doi: http://dx.doi.org/10.1177/0884533611414029.
  40. Kopple J.D. Nutrition, Diet, and the Kidney. In: Ross A.C., Caballero B., Cousins R.J., Tucker K.L., Ziegler T.R. (eds.). Modern nutrition in health and disease. 11th ed. Baltimore MD: Lippincott Williams & Wilkins; 2014. Р. 1330–1371.
  41. Reintam Blaser A., Starkopf J., Alhazzani W, Berger M.M., et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380–398. Doi: http://dx.doi.org/10.1007/s00134-016-4665-0.
  42. Rice T.W., Wheeler A.P., Thompson B.T., Steingrub J., Hite R.D., Moss M., Morris A., Dong N., Rock P. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012;307(8):795–803. Doi: http://dx.doi.org/10.1001/jama.2012.137.
  43. Casaer M.P., van den Berghe G. Nutrition in the acute phase of critical illness. N. Engl. J. Med. 2014;370(13):1227–1236. Doi: http://dx.doi.org/10.1056/NEJMra1304623.
  44. Arabi Y.M., Aldawood A.S., Al-Dorzi H.M., Tamim H.M., et al. Permissive underfeeding or standard enteral feeding in critically ill adults. N. Engl. J. Med. 2015;372:2398–2408. Doi: http://dx.doi.org/10.1056/NEJMoa1502826.
  45. Marik P.E., Hooper M.H. Normocaloric versus hypocaloric feeding on the outcomes of ICU patients: a systematic review and metaanalysis. Intensive Care Med. 2015;2(3):316–323. Doi: http://dx.doi.org/10.1007/s00134-015-4131-4.
  46. Singer P., Berger M.M., Van den Berghe G., Biolo G., Calder P., Forbes A., Griffiths R., Kreyman G., Leverve X., Pichard C., ESPEN. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin. Nutr. 2009;28(4):387–400. Doi: http://dx.doi.org/10.1016/j.clnu.2009.04.024.
  47. Heidegger C.P., Berger M.M., Graf S., Zingg W., Darmon P., Costanza M.C., Thibault R., Pichard C. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013;381(9864):385–393. Doi: http://dx.doi.org/10.1016/S0140-6736(12)61351-8.
  48. Metnitz P.G., Krenn C.G., Steltzer H., Lang T., Ploder J., Lenz K., Le Gall J.R., Druml W. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit. Care Med. 2002;30(9):2051–2058. Doi: http://dx.doi.org/10.1097/01.CCM.0000026732.62103.DF.
  49. Horoshilov S.E., Yarustovskij M.B., Shestopalov A.E., Nikulin A.V. Nutritional support for acute and chronic renal failure. V kn.: M.Sh. Hubutiya, T.S. Popova, A.I. Saltanov (red.). Parenteral and enteral nutrition: national guidelines. M., 2014. Р. 490–507.
  50. Kazory A., Clapp W.L., Ejaz A.A., Ross E.A. Shortened hemofilter survival time due to lipid infusion in continuous renal replacement therapy. Nephron. Clin. Pract. 2008;108(1):5–9. Doi: http://dx.doi.org/10.1159/000112043.
  51. Fiaccadori E., Regolisti G., Maggiore U. Specialized nutritional support interventions in critically ill patients on renal replacement therapy. Curr. Opin. Clin. Nutr. Metab. Care. 2013;16(2):217–224. Doi: http://dx.doi.org/10.1097/MCO.0b013e32835c20b0.
  52. Berger M.M., Shenkin A., Revelly J.P., Roberts E., Cayeux M.C., Baines M., Chioléro R.L. Copper, selenium, zinc, and thiamine balances during continuous venovenous hemodiafiltration in critically ill patients. Am. J. Clin. Nutr. 2004;80(2):410–416. Doi: http://dx.doi.org/10.1093/ajcn/80.2.410.
  53. Fiaccadori E., Cremaschi E., Regolisti G. Nutritional assessment and delivery in renal replacement therapy patients. Semin. Dial. 2011;24(2):169–175. Doi: http://dx.doi.org/10.1111/j.1525-139X.2011.00831.x.
  54. Friedman A.L., Chesney R.W., Gilbert E.F., Gilchrist K.W., Latorraca R., Segar W.E. Secondary oxalosis as a complication of parenteral alimentation in acute renal failure. Am. J. Nephrol. 1983;3(5):248–252. Doi: http://dx.doi.org/10.1159/000166724.
  55. Gerlach T.H., Zile M.H. Upregulation of serum retinol in experimental acute renal failure. Faseb. J. 1990(8);4:2511–2517.
  56. Druml W., Schwarzenhofer M., Apsner R., Hörl W.H. Fat- soluble vitamins in patients with acute renal failure. Miner. Electrolyte Metab. 1998;24(4):220–226.
  57. Druml W. Acute renal failure is not a “cute” renal failure! Intensive Care Med. 2004;30(10):1886–1890. Doi: http://dx.doi.org/10.1007/s00134-004-2344-z.
  58. Oudemans-van Straaten H.M., Kellum J.A., Bellomo R. Clinical review: anticoagulation for continuous renal replacement therapy-heparin or citrate? Crit. Care. 2011;15(1):202–212. Doi: http://dx.doi.org/10.1186/cc9358.
  59. Balik M., Zakharchenko M., Leden P., Otahal M., et al. Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration – a comparison between 2 citrate modalities and unfractionated heparin. Crit. Care. 2013;28(1):87–95. Doi: http://dx.doi.org/10.1016/j.jcrc.2012.06.003.
  60. Santiago M.J., López-Herce J., Urbano J., Bellón J.M., del Castillo J, Carrillo A. Hypophosphatemia and phosphate supplementation during continuous renal replacement therapy in children. Kidney Int. 2009;75(3):312–316. Doi: http://dx.doi.org/10.1038/ki.2008.570.
  61. Bugg N.C., Jones J.A. Hypophosphataemia. Pathophysiology, effects and management on the intensive care unit. Anaesthesia. 1998;53(9):895–902. Doi: http://dx.doi.org/10.1046/j.1365-2044.1998.00463.x.
  62. Demirjian S., Teo B.W., Guzman J.A., Heyka R.J., Paganini E.P., Fissell W.H., Schold J.D., Schreiber M.J. Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury. Nephrol. Dial. Transplant. 2011;26 (11):3508–3514. Doi: http://dx.doi.org/10.1093/ndt/gfr075.
  63. Morabito S., Pistolesi V., Tritapepe L., Fiaccadori E. Regional citrate anticoagulation for RRTs in critically ill patients with AKI. Clin. J. Am. Soc. Nephrol. 2014;9(12):2173–2188. Doi: http://dx.doi.org/10.2215/CJN .01280214.
  64. Yagi N., Leblanc M., Sakai K., Wright E.J., Paganini E.P. Cooling effect of continuous renal replacement therapy in critically ill patients. Am. J. Kidney Dis. 1998;32(6):1023–1030.
  65. Manns M., Maurer E., Steinbach B., Evering H.G. Thermal energy balance during in vitro continuous hemofiltration. ASAIO J. 1998;44(5):601–605. Doi: http://dx.doi.org/10.1097/00002480-199809000-00060.


Об авторах / Для корреспонденции


Ильинский М.Е. – к.м.н., научный сотрудник отделения общей реанимации ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»; Москва, Россия. Е-mail: tribusverbis@gmail.com
Лященко Ю.Н. – д.м.н., проф., научный консультант ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»; Москва, Россия.
Рей С.И. – к.м.н., старший научный сотрудник отепления неотложной хирургии, эндоскопии и интенсивной терапии ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»; Москва, Россия.
Петриков С.С. – д.м.н., проф. РАН, директор ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»; Москва, Россия.


Похожие статьи


Бионика Медиа