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

Bellomo, Rinaldo, Cass, Alan, Cole, Louise, Finfer, Simon, Gallagher, Martin, Lee, Joanne, Lo, Serigne, McArthur, Colin, McGuinness, Shay, Myburgh, John, Norton, Robyn, Scheinkestel, Carlos, Orford, Neil and RENAL Study Investigators 2014, 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, Critical care, vol. 18, pp. 1-11, doi: 10.1186/cc13767.

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Title 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
Author(s) Bellomo, Rinaldo
Cass, Alan
Cole, Louise
Finfer, Simon
Gallagher, Martin
Lee, Joanne
Lo, Serigne
McArthur, Colin
McGuinness, Shay
Myburgh, John
Norton, Robyn
Scheinkestel, Carlos
Orford, NeilORCID iD for Orford, Neil orcid.org/0000-0002-2285-9233
RENAL Study Investigators
Journal name Critical care
Volume number 18
Article ID R45
Start page 1
End page 11
Total pages 11
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2014-03-14
ISSN 1466-609X
Keyword(s) caloric intake (DCI)
acute kidney injury (AKI)
renal replacement therapy (RRT)
calorie administration
Summary 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.
Language eng
DOI 10.1186/cc13767
Indigenous content off
Field of Research 11 Medical And Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2014, Bellomo et al.
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30115282

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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