Metabolic Alterations in Acute Renal Failure

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Energy metabolism

FIGURE 18-3

Energy metabolism in acute renal failure (ARF). In experimental animals ARF decreases oxygen consumption even when hypothermia and acidosis are corrected (uremic hypometabolism) [3]. In contrast, in the clinical setting oxygen consumption of patients with various form of renal failure is remarkably little changed [4]. In subjects with chronic renal failure (CRF), advanced uremia (UA), patients on regular hemodialysis therapy (HD) but also in patients with uncomplicated ARF (ARFNS) resting energy expenditure (REE) was comparable to that seen in controls (N). However, in patients with ARF and sepsis (ARFS) REE is increased by approximately 20%.

Thus, energy expenditure of patients with ARF is more determined by the underlying disease than acute uremic state and taken together these data indicate that when uremia is well-controlled by hemodialysis or hemofiltration there is little if any change in energy metabolism in ARF. In contrast to many other acute disease processes ARF might rather decrease than increase REE because in multiple organ dysfunction syndrome oxygen consumption was significantly higher in patients without impairment of renal function than in those with ARF [5]. (From Schneeweiss [4]; with permission.)

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