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Cited by 65Acute Kidney Injury ResearchClinical Nutrition and GastroenterologyDialysis and Renal Disease Management

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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Bellomo, Rinaldo, Cass, Alan, Cole, Louise, Finfer, Simon, Gallagher, Martin, Lee, Joanne, Lo, Serigne, McArthur, Colin +5 more·2014·Critical Care
DOI 10.1186/cc13767PMC PMC4057152
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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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  • Large observational series have observed that the optimal calorie load associated with the best survival is around 80% of predicted energy needs, whereas others suggested no relation between intake and outcome or better outcome with lower energy intakes.

    “Large observational series including hundreds to thousands of patients have observed that the optimal calorie load associated with the best survival is around 80% of predicted energy needs [53], whereas others suggested no relation between intake and outcome or better outcome with lower energy intakes [54].”

    From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [54]

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  • RCTs did not confirm the expected benefit of higher protein intakes alone, or combined with physical activity or energy.

    “However, RCTs did not confirm the expected benefit of higher protein intakes alone, or combined with physical activity or energy [37,54,58].”

    From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [54]

    The Abstract Conclusions report that greater daily calorie intake was not associated with improved outcomes in patients with severe acute kidney injury. But the Methods (Daily calorie intake) say nutrition was not assigned by protocol and calories excluded protein nitrogen; the Discussion (Study strengths and limitations) calls these observational findings from a trial of kidney-replacement therapy. This paper therefore does not establish that an RCT found no benefit from higher protein intake, alone or in combination with activity or energy. (LLM, conf=0.87)

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Authors
Bellomo, R., Cass, A., Cole, L., Finfer, S., Gallagher, M., Lee, J., Lo, S., McArthur, C., McGuinness, S., Myburgh, J., Norton, R., Scheinkestel, C., & The RENAL Study Investigators
Affiliations
  • Austin Hospital (AU)
  • The George Institute for Global Health (AU)
  • Nepean Hospital (AU)
  • Royal North Shore Hospital (AU)
  • Auckland City Hospital (NZ)
  • St George Hospital (AU)
  • The Alfred Hospital (AU)
Corresponding author
Bellomo, Rinaldo
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2014-03-14
Volume
18
Issue
2
Pages
R45-R45
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/cc13767
PMC
PMC4057152
OpenAlex
W1999039174
Cited by
65
References
40
Citations by year
2026: 3 · 2025: 5 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 8 · 2020: 3 · 2019: 2 · 2018: 8 · 2017: 5 · 2016: 4 · 2015: 12 · 2014: 1 · 2013: 1
FWCI
5.80
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • CDU eSpace Institutional Repository (Charles Darwin University) (submittedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
  • Own your potential (DEAKIN) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Spiral (Imperial College London) (submittedVersion, cc-by)
Funders
  • ACT Government
  • Intensive Care Society
  • Royal Adelaide Hospital
  • St Vincent's Hospital Melbourne
  • Medical Research Council
  • National Health and Medical Research Council (352550)
Topics
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
severe acute kidney injury, energy intake, energy supplementation, renal replacement therapy, 90-day mortality, nutritional support, critically ill patients, mechanical ventilation duration, ICU length of stay
MeSH terms
Aged, Aged, 80 and over, Energy Intake, Female, Humans, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Renal Replacement Therapy, Acute Kidney Injury

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