From the Guidelines
The recommended total energy consumption for a patient with Acute Kidney Injury (AKI) is 20-30 kcal/kg/d.
Rationale
- This recommendation is based on the KDIGO clinical practice guideline for acute kidney injury, which suggests achieving a total energy intake of 20-30 kcal/kg/d in patients with any stage of AKI 1.
- The ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease also supports this recommendation, stating that at least 75% of calculated energy and protein requirements should be achieved in order to reduce the risk of adverse outcomes 1.
- However, it is also important to avoid overfeeding, especially in the early phase of acute illness, and to progressively increase caloric delivery up to 80-100% of measured energy expenditure after day three 1.
- The optimal energy intake may vary depending on the individual patient's needs and circumstances, and should be determined on a case-by-case basis.
Key Considerations
- The route of nutrition, whether oral, enteral, or parenteral, should be considered when determining the optimal energy intake 1.
- The timing of nutrition therapy is also important, with early nutrition therapy being associated with better outcomes in patients with AKI 1.
- Indirect calorimetry can be used to estimate energy needs and guide nutrition therapy, but predictive equations can also be used if indirect calorimetry is not available 1.
From the Research
Recommended Total Energy Consumption for AKI Patients
The recommended total energy consumption for patients with Acute Kidney Injury (AKI) varies depending on the stage of AKI and the patient's overall condition.
- A caloric intake of 20-30 kcal/kg body weight (BW)/day is recommended for all stages of AKI 2.
- For patients with AKI on renal replacement therapy, a caloric intake of 25 to 30 kcal/kg is recommended to minimize protein catabolism and prevent metabolic complications 3.
- The energy target should be gradually increased to meet 80%-100% of the energy target, with low energy intake suggested in critically ill patients with AKI 2.
- No more than 30 kcal nonprotein calories or 1.3 x BEE (basal energy expenditure) calculated by the Harris-Benedict equation is recommended for patients with AKI on renal replacement therapy 4.
Importance of Individualized Nutrition Support
It is essential to note that nutritional requirements for AKI patients should be frequently reassessed, individualized, and carefully integrated with renal replacement therapy 4.
- Conventional predictive formulas may frequently lead to incorrect energy and protein need estimation, and actual energy and protein needs should be measured by indirect calorimetry and protein catabolic rate whenever possible 5.
- Early enteral nutrition is suggested, and parenteral nutrition is needed when >60% energy and protein requirements cannot be met via the enteral route in 7-10 days 2.