Elsevier

Clinical Nutrition

Volume 28, Issue 4, August 2009, Pages 401-414
Clinical Nutrition

ESPEN Guidelines on Parenteral Nutrition: Adult Renal Failure

https://doi.org/10.1016/j.clnu.2009.05.016Get rights and content

Summary

Among patients with renal failure, those with ARF and critical illness represent by far the largest group undergoing artificial nutrition. ARF, especially in the ICU, seldom occurs as isolated organ failure but rather is a component of a much more complex metabolic environment, in the setting of the multiple organ failure. Nutritional programs for ARF patients must consider not only the metabolic derangements peculiar to renal failure and with the underlying disease process/associated complications, but also the relevant derangements in nutrient balance due to renal replacement therapies, especially when highly efficient renal replacement therapies (RRT) are used, such as continuous veno-venous hemofiltration (CVVH), or prolonged intermittent modalities such as sustained low-efficiency dialysis (SLED). Finally it is to be taken into account that nutrient requirements can change considerably during the course of illness itself (see also guidelines on PN in intensive care).

From a metabolic point of view, patients with CKD or on chronic HD who develop a superimposed acute illness should be considered to be similar to patients with ARF. The same principles in respect of PN should therefore be applied.

Section snippets

Preliminary remarks

The present guidelines address the indications for parenteral nutrition (PN) in renal patients with malnutrition in a similar way to the previously published guidelines on enteral nutrition (EN).1 As mentioned in these EN guidelines, patients with renal failure represent a heterogeneous group and their nutritional requirements vary according to the clinical setting. A large body of evidence supports the use of the enteral rather than the parenteral route for nutrient administration.1 However,

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