Figure 1813

Amino acid and protein requirements of patients with acute renal failure (ARF). The optimal intake of protein or amino acids is affected more by the nature of the underlying cause of ARF and the extent of protein catabolism and type and frequency of dialysis than by kidney dysfunction per se. Unfortunately, only a few studies have attempted to define the optimal requirements for protein or amino acids in ARF:

In nonhypercatabolic patients, during the polyuric phase of ARF protein intake of 0.97 g/kg body weight per day was required to achieve a positive nitrogen balance [25]. A similar number (1.03g/kg body weight per day) was derived from a study in which, unfortunately, energy intake was not kept constant [6]. In the polyuric recovery phase in patients with sepsis-induced ARF, a nitrogen intake of 15 g/day (averaging an amino acid intake of 1.3 g/kg body weight per day) as compared to 4.4 g/kg per day (about 0.3 g/kg amino acids) was superior in ameliorating nitrogen balance [26].

Several recent studies have tried to evaluate protein and amino acid requirements of critically ill patients with ARF. Kierdorf and associates found that, in these hypercatabolic patients receiving continuous hemofiltration therapy, the provision of amino acids 1.5 g /kg body weight per day was more effective in reducing nitrogen loss than infusion of 0.7 g (-3.4 versus -8.1 g nitrogen per day) [27]. An increase of amino acid intake to 1. 74 g/kg per day did not further ameliorate nitrogen balance.

Chima and coworkers measured a mean PCR of 1.7 g kg body weight per day in 19 critically ill ARF patients and concluded that protein needs in these patients range between 1.4 and 1.7 g/kg per day [28]. Similarly, Marcias and coworkers have obtained a protein catabolic rate (PCR) of 1.4 g/kg per day and found an inverse relationship between protein and energy provision and PCR and again recommended protein intake of 1.5 to 1.8 g/kg per day [29]. Similar conclusions were drawn by Ikitzler in evaluating ARF patients on intermittent hemodialysis therapy [30]. (From Kierdorf et al. [27]; with permission.)

Glucose metabolism

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