Clinical study of CRRT effect on energy metabolism and thermal balance in ICU patients with acute kidney injury
10.3760/cma.j.issn.1671-0282.2025.02.016
- VernacularTitle:连续性肾脏替代治疗对ICU急性肾损伤患者能量代谢与热量平衡的影响
- Author:
Jianping GAO
1
;
Yonggang WANG
;
CongCong LI
;
Liping TANG
;
Xinhao JIN
;
Konghan PAN
Author Information
1. 浙江大学医学院附属邵逸夫医院重症医学科，浙江省腹腔感染精准诊疗重点实验室，杭州 310016
- Keywords:
Acute kidney injury;
Continuous renal replacement therapy;
Energy metabolism;
Body temperature change;
Nutrition assessment;
Glucose;
Citrate;
Lactate
- From:
Chinese Journal of Emergency Medicine
2025;34(2):233-240
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of continuous renal replacement therapy (CRRT) on energy metabolism and thermal balance in ICU patients with acute kidney injury (AKI).Methods:This study was a prospective observational study, which included AKI patients who underwent CRRT in ICU of the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from May 2020 to December 2023. The patients' general clinical characteristics, comorbidities, body temperature, disease severity score, CRRT treatment time and filter lifespan were recorded. The concentrations of glucose and lactate in blood and ultrafiltrate, and the citrate level in the ultrafiltrate when regional citrate anticoagulation adopted were analyzed regularly. Subgroup analysis was carried out according to different anticoagulation modes and whether the patients with diabetes or shock. The changes of energy metabolism and thermal balance corresponding to the changes in glucose, lactate, citrate and body temperature induced by CRRT were calculated daily.Results:This study included 420 AKI patients undergoing CRRT. When the blood lactate was between 14-18 mmol/L, there was a loss of approximately 200-250 kcal of energy per day, while the blood lactate was between 6.5-11.5 mmol/L, the daily corresponding energy loss was about 100-150 kcal. During CRRT on the first day, the patients with diabetes or shock had a mild decrease of blood glucose, while patients without diabetes and shock had mild increase of blood glucose. When the target of blood glucose was gradually achieved, the mean daily increase of energy corresponding to blood glucose intake was about 100-130 kcal in patients undergoing CRRT. The mean daily increase of energy corresponding to citrate intake was approximately 330 kcal, when the patient was undertaken by CRRT with regional citrate anticoagulation. For every 1℃ decrease in body temperature, the mean daily heat loss caused by extracorporeal thermal radiation during CRRT was about 200 kcal.Conclusions:When conducting nutritional assessment and prescription for AKI patients supported by CRRT in the ICU, it is essential to fully consider the impact of CRRT on the patient's energy metabolism and heat balance. This includes the clearance of lactate, the balance of blood glucose, the intake of citrate, and the reduction in body temperature. Additionally, the type and stage of the disease, as well as individual differences, must be taken into account to achieve personalized nutritional assessment and precise implementation.
