Abstract
Introduction:
The energy and protein target can be expressed as E/P(energy to protein ratio) and can be used to guide the
choice of medical nutrition. ESPEN guidelines still advocate energy prescription based on indirect calorimetry
(IC) adapted for the non-nutritional calories. (1)
Continuous venovenous hemofiltration (CVVH), which is a type of continuous renal replacement therapy will
alter energy and protein targets due to exchange of nutrients. (2,3)
We aimed to evaluate how the E/P needs changes due to CVVH and how this could impact the choice of
available parenteral medical nutrition.
Methods:
A retrospective analysis was performed on adult ICU patients admitted between 01/01 and 31/12/2022 treated
with CVVH who had at least one IC measurement. We calculated the energy target based on REE(resting energy
expenditure) measured with IC from which the bioenergetic balance of the CVVH was deducted. The E/P of each
subject was calculated.
Results:
A total of 45 IC measurements were included. When citrate was used, E/P ratio was 10,28 ± 2,44 Kcal/gr
compared to 15,95 ± 3,15Kcal/gr when citrate was not used which was statistically significant different (p<0,01).
During Citrate predilution Olimel N12 concurred in 20,7% of cases as compared to 10,3% with SMOFKabiven
Extra Amino and 0% with Olimel N9 and SMOFKabiven.
Conclusion:
Patients treated with CVVH have a specific E/P ratio which can be further stratified based on citrate use. Olimel
N12 is the most appropriate parenteral nutrition in CVVH patients treated with citrate. Further pharmaceutical
developments are necessary to develop ready to use parenteral nutrition to individualize the nutritional therapy
in CVVH patients.
References:
(1) Singer P et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit.
(2) Fiaccadori E et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney
disease.
(3) Jonckheer J et al. Bioenergetic balance of CVVH. A post hoc analysis of the MECCIAS trial.
The energy and protein target can be expressed as E/P(energy to protein ratio) and can be used to guide the
choice of medical nutrition. ESPEN guidelines still advocate energy prescription based on indirect calorimetry
(IC) adapted for the non-nutritional calories. (1)
Continuous venovenous hemofiltration (CVVH), which is a type of continuous renal replacement therapy will
alter energy and protein targets due to exchange of nutrients. (2,3)
We aimed to evaluate how the E/P needs changes due to CVVH and how this could impact the choice of
available parenteral medical nutrition.
Methods:
A retrospective analysis was performed on adult ICU patients admitted between 01/01 and 31/12/2022 treated
with CVVH who had at least one IC measurement. We calculated the energy target based on REE(resting energy
expenditure) measured with IC from which the bioenergetic balance of the CVVH was deducted. The E/P of each
subject was calculated.
Results:
A total of 45 IC measurements were included. When citrate was used, E/P ratio was 10,28 ± 2,44 Kcal/gr
compared to 15,95 ± 3,15Kcal/gr when citrate was not used which was statistically significant different (p<0,01).
During Citrate predilution Olimel N12 concurred in 20,7% of cases as compared to 10,3% with SMOFKabiven
Extra Amino and 0% with Olimel N9 and SMOFKabiven.
Conclusion:
Patients treated with CVVH have a specific E/P ratio which can be further stratified based on citrate use. Olimel
N12 is the most appropriate parenteral nutrition in CVVH patients treated with citrate. Further pharmaceutical
developments are necessary to develop ready to use parenteral nutrition to individualize the nutritional therapy
in CVVH patients.
References:
(1) Singer P et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit.
(2) Fiaccadori E et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney
disease.
(3) Jonckheer J et al. Bioenergetic balance of CVVH. A post hoc analysis of the MECCIAS trial.
| Original language | English |
|---|---|
| Publication status | Published - 19 Mar 2024 |
| Event | NTERNATIONAL SYMPOSIUM ON INTENSIVE CARE & EMERGENCY MEDICINE - Brussels congress center, Brussels, Belgium Duration: 19 Mar 2024 → 22 Mar 2024 Conference number: 43 |
Conference
| Conference | NTERNATIONAL SYMPOSIUM ON INTENSIVE CARE & EMERGENCY MEDICINE |
|---|---|
| Abbreviated title | ISICEM |
| Country/Territory | Belgium |
| City | Brussels |
| Period | 19/03/24 → 22/03/24 |