Key result
Augmented renal clearance in critically ill trauma patients was associated with a significantly lower nitrogen balance (-6 vs -4 g/day, p=0.0002) and increased muscle loss over the first 10 days.
Why the study?
Is augmented renal clearance associated with increased urinary nitrogen loss and muscle wasting in critically ill trauma patients?
Cohort (n=162)
No
Is augmented renal clearance associated with increased urinary nitrogen loss and muscle wasting in critically ill trauma patients?
In critically ill trauma patients, augmented renal clearance is associated with lower nitrogen balance and increased muscle loss during the first 10 days of ICU admission.
ARC was associated with urinary nitrogen loss and muscle wasting in trauma ICU patients; leaves open whether ARC-targeted nutrition improves outcomes.
The main objective of this pilot study was to determine the association between augmented renal clearance (ARC), urinary nitrogen loss and muscle wasting in critically ill trauma patients. We conducted a retrospective analysis of a local database in 162 critically ill trauma patients without chronic renal dysfunction. Nutritional-related parameters and 24 h urinary biochemical analyses were prospectively collected and averaged over the first ten days after admission. Augmented renal clearance was defined by a mean creatinine clearance (CLCR) > 130 mL/min/1.73 m2. The main outcome was the cumulated nitrogen balance at day 10. The secondary outcome was the variation of muscle psoas cross-sectional area (ΔCSA) calculated in the subgroup of patients who underwent at least two abdominal CT scans during the ICU length of stay. Overall, there was a significant correlation between mean CLCR and mean urinary nitrogen loss (normalized coefficient: 0.47 ± 0.07, p < 0.0001). ARC was associated with a significantly higher urinary nitrogen loss (17 ± 5 vs. 14 ± 4 g/day, p < 0.0001) and a lower nitrogen balance (−6 ± 5 vs. −4 ± 5 g/day, p = 0.0002), without difference regarding the mean protein intake (0.7 ± 0.2 vs. 0.7 ± 0.3 g/kg/day, p = 0.260). In the subgroup of patients who underwent a second abdominal CT scan (N = 47), both ΔCSA and %ΔCSA were higher in ARC patients (−33 [−41; −25] vs. −15 [−29; −5] mm2/day, p = 0.010 and −3 [−3; −2] vs. −1 [−3; −1] %/day, p = 0.008). Critically ill trauma patients with ARC are thus characterized by a lower nitrogen balance and increased muscle loss over the 10 first days after ICU admission. The interest of an increased protein intake (>1.5 g/kg/day) in such patients remains a matter of controversy and must be confirmed by further randomized trials.
No takes yet. Share an insight, caveat, or question.
Dreydemy et al. (2021) conducted a cohort in Critically ill trauma (n=162). Augmented renal clearance vs. No augmented renal clearance was evaluated on Cumulated nitrogen balance at day 10 (p=0.0002). Augmented renal clearance in critically ill trauma patients was associated with a significantly lower nitrogen balance (-6 vs -4 g/day, p=0.0002) and increased muscle loss over the first 10 days.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: