Calorie intake and patient outcomes in severe acute kidney injury

Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial

Rinaldo Bellomo, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Joanne Lee, Serigne Lo, Colin McArthur, Shay McGuinness, John Myburgh, Robyn Norton, Carlos Scheinkestel, Imogen Mitchell, Rebecca Ashley, Jelena Gissane, Katya Malchukova, Jamie Ranse, Asif Raza, Kiran Nand, Treena Sara & 114 others David Millis, Jeff Tan, Helen Wong, Peter Harrigan, Elise Crowfoot, Miranda Hardie, Deepak Bhonagiri, Sharon Micallef, Jorge Brieva, Melissa Lintott, Rebecca Gresham, Maria Nikas, Leonie Weisbrodt, Yahya Shehabi, Frances Bass, Michelle Campbell, Victoria Stockdale, Susan Ankers, Anne O'Connor, Julie Potter, Richard Totaro, Dorrilyn Rajbhandari, Vanessa Dhiacou, Alina Jovanovska, Francesca Munster, Priya Nair, Jeff Breeding, Claire Burns, Ashoke Banerjee, Maridy Morrison, Caroline Pfeffercorn, Anne Ritchie, Heidi Buhr, Michelle Eccleston, Rachael Parke, Jeanette Bell, Lynette Newby, Seton Henderson, Jan Mehrtens, Michael Kalkoff, Cathy West, John Morgan, Lorraine Rudder, Joanne Sutton, Peter Garrett, Nicole Groves, Shona McDonald, and Jennifer Palmer, Chris Joyce, Meg Harwood, Jean Helyar, Benjamin Mackie, Jeff Lipman, Robert Boots, Claire Bertenshaw, Renae Deans, Cheryl Fourie, Melissa Lassig-Smith, Arthas Flabouris, Jason Edwards, Stephanie O'Connor, Justine Rivett, Andrew Turner, Tanya Field, Kathryn Marsden, Claire Mathlin, Donna Goldsmith, Inga Mercer, Kim O'Sullivan, John Edington, Catherine Boschert, Julie Smith, Benno Ihle, Michael Graan, Samuel Ho, John Botha, Nina Fowler, Jodi McInness, Naomi Pratt, Neil Orford, Tania Elderkin, Melissa Fraser, Anne Kinmonth, Christopher Wright, Sue Burton, Carly Culhane, Pauline Galt, Rebecca Rutzou, Megan Roberston, Deborah Barge, Tania Caf, Belinda Howe, Patzy Low, Antony Tobin, Jennifer Holmes, Roger Smith, Andrew Davies, Lynne Murray, Rachael Nevill, Shirley Vallance, Sue Varley, Vickie White, Craig French, Lorraine Little, Heike Raunow, David Blythe, Anna Palermo, Geoff Dobb, Melanie Boardman, Jenny Chamberlain, Andree Gould, Geraldine McEntaggart, Samantha Perryman, Linda Thomas

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Abstract

Introduction: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes.

Methods: We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models.

Results: Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling.

Conclusions: In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes.

Original languageEnglish
Article numberR45
Pages (from-to)1-11
Number of pages11
JournalCritical Care
Volume18
Issue number2
DOIs
Publication statusPublished - 2014

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Energy Intake
Acute Kidney Injury
Therapeutics
Logistic Models
Renal Replacement Therapy
Random Allocation
Artificial Respiration
Proportional Hazards Models
Survivors
Odds Ratio
Regression Analysis
Confidence Intervals
Kidney
Mortality

Cite this

Bellomo, Rinaldo ; Cass, Alan ; Cole, Louise ; Finfer, Simon ; Gallagher, Martin ; Lee, Joanne ; Lo, Serigne ; McArthur, Colin ; McGuinness, Shay ; Myburgh, John ; Norton, Robyn ; Scheinkestel, Carlos ; Mitchell, Imogen ; Ashley, Rebecca ; Gissane, Jelena ; Malchukova, Katya ; Ranse, Jamie ; Raza, Asif ; Nand, Kiran ; Sara, Treena ; Millis, David ; Tan, Jeff ; Wong, Helen ; Harrigan, Peter ; Crowfoot, Elise ; Hardie, Miranda ; Bhonagiri, Deepak ; Micallef, Sharon ; Brieva, Jorge ; Lintott, Melissa ; Gresham, Rebecca ; Nikas, Maria ; Weisbrodt, Leonie ; Shehabi, Yahya ; Bass, Frances ; Campbell, Michelle ; Stockdale, Victoria ; Ankers, Susan ; O'Connor, Anne ; Potter, Julie ; Totaro, Richard ; Rajbhandari, Dorrilyn ; Dhiacou, Vanessa ; Jovanovska, Alina ; Munster, Francesca ; Nair, Priya ; Breeding, Jeff ; Burns, Claire ; Banerjee, Ashoke ; Morrison, Maridy ; Pfeffercorn, Caroline ; Ritchie, Anne ; Buhr, Heidi ; Eccleston, Michelle ; Parke, Rachael ; Bell, Jeanette ; Newby, Lynette ; Henderson, Seton ; Mehrtens, Jan ; Kalkoff, Michael ; West, Cathy ; Morgan, John ; Rudder, Lorraine ; Sutton, Joanne ; Garrett, Peter ; Groves, Nicole ; McDonald, Shona ; Jennifer Palmer, and ; Joyce, Chris ; Harwood, Meg ; Helyar, Jean ; Mackie, Benjamin ; Lipman, Jeff ; Boots, Robert ; Bertenshaw, Claire ; Deans, Renae ; Fourie, Cheryl ; Lassig-Smith, Melissa ; Flabouris, Arthas ; Edwards, Jason ; O'Connor, Stephanie ; Rivett, Justine ; Turner, Andrew ; Field, Tanya ; Marsden, Kathryn ; Mathlin, Claire ; Goldsmith, Donna ; Mercer, Inga ; O'Sullivan, Kim ; Edington, John ; Boschert, Catherine ; Smith, Julie ; Ihle, Benno ; Graan, Michael ; Ho, Samuel ; Botha, John ; Fowler, Nina ; McInness, Jodi ; Pratt, Naomi ; Orford, Neil ; Elderkin, Tania ; Fraser, Melissa ; Kinmonth, Anne ; Wright, Christopher ; Burton, Sue ; Culhane, Carly ; Galt, Pauline ; Rutzou, Rebecca ; Roberston, Megan ; Barge, Deborah ; Caf, Tania ; Howe, Belinda ; Low, Patzy ; Tobin, Antony ; Holmes, Jennifer ; Smith, Roger ; Davies, Andrew ; Murray, Lynne ; Nevill, Rachael ; Vallance, Shirley ; Varley, Sue ; White, Vickie ; French, Craig ; Little, Lorraine ; Raunow, Heike ; Blythe, David ; Palermo, Anna ; Dobb, Geoff ; Boardman, Melanie ; Chamberlain, Jenny ; Gould, Andree ; McEntaggart, Geraldine ; Perryman, Samantha ; Thomas, Linda. / Calorie intake and patient outcomes in severe acute kidney injury : Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial. In: Critical Care. 2014 ; Vol. 18, No. 2. pp. 1-11.
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title = "Calorie intake and patient outcomes in severe acute kidney injury: Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial",
abstract = "Introduction: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes.Methods: We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models.Results: Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8{\%}) had died at 90-days after randomization compared with 316 of 727 (43.3{\%}) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95{\%} confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling.Conclusions: In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes.",
author = "Rinaldo Bellomo and Alan Cass and Louise Cole and Simon Finfer and Martin Gallagher and Joanne Lee and Serigne Lo and Colin McArthur and Shay McGuinness and John Myburgh and Robyn Norton and Carlos Scheinkestel and Imogen Mitchell and Rebecca Ashley and Jelena Gissane and Katya Malchukova and Jamie Ranse and Asif Raza and Kiran Nand and Treena Sara and David Millis and Jeff Tan and Helen Wong and Peter Harrigan and Elise Crowfoot and Miranda Hardie and Deepak Bhonagiri and Sharon Micallef and Jorge Brieva and Melissa Lintott and Rebecca Gresham and Maria Nikas and Leonie Weisbrodt and Yahya Shehabi and Frances Bass and Michelle Campbell and Victoria Stockdale and Susan Ankers and Anne O'Connor and Julie Potter and Richard Totaro and Dorrilyn Rajbhandari and Vanessa Dhiacou and Alina Jovanovska and Francesca Munster and Priya Nair and Jeff Breeding and Claire Burns and Ashoke Banerjee and Maridy Morrison and Caroline Pfeffercorn and Anne Ritchie and Heidi Buhr and Michelle Eccleston and Rachael Parke and Jeanette Bell and Lynette Newby and Seton Henderson and Jan Mehrtens and Michael Kalkoff and Cathy West and John Morgan and Lorraine Rudder and Joanne Sutton and Peter Garrett and Nicole Groves and Shona McDonald and {Jennifer Palmer}, and and Chris Joyce and Meg Harwood and Jean Helyar and Benjamin Mackie and Jeff Lipman and Robert Boots and Claire Bertenshaw and Renae Deans and Cheryl Fourie and Melissa Lassig-Smith and Arthas Flabouris and Jason Edwards and Stephanie O'Connor and Justine Rivett and Andrew Turner and Tanya Field and Kathryn Marsden and Claire Mathlin and Donna Goldsmith and Inga Mercer and Kim O'Sullivan and John Edington and Catherine Boschert and Julie Smith and Benno Ihle and Michael Graan and Samuel Ho and John Botha and Nina Fowler and Jodi McInness and Naomi Pratt and Neil Orford and Tania Elderkin and Melissa Fraser and Anne Kinmonth and Christopher Wright and Sue Burton and Carly Culhane and Pauline Galt and Rebecca Rutzou and Megan Roberston and Deborah Barge and Tania Caf and Belinda Howe and Patzy Low and Antony Tobin and Jennifer Holmes and Roger Smith and Andrew Davies and Lynne Murray and Rachael Nevill and Shirley Vallance and Sue Varley and Vickie White and Craig French and Lorraine Little and Heike Raunow and David Blythe and Anna Palermo and Geoff Dobb and Melanie Boardman and Jenny Chamberlain and Andree Gould and Geraldine McEntaggart and Samantha Perryman and Linda Thomas",
year = "2014",
doi = "10.1186/cc13767",
language = "English",
volume = "18",
pages = "1--11",
journal = "Critical Care",
issn = "1364-8535",
publisher = "BioMed Central",
number = "2",

}

Bellomo, R, Cass, A, Cole, L, Finfer, S, Gallagher, M, Lee, J, Lo, S, McArthur, C, McGuinness, S, Myburgh, J, Norton, R, Scheinkestel, C, Mitchell, I, Ashley, R, Gissane, J, Malchukova, K, Ranse, J, Raza, A, Nand, K, Sara, T, Millis, D, Tan, J, Wong, H, Harrigan, P, Crowfoot, E, Hardie, M, Bhonagiri, D, Micallef, S, Brieva, J, Lintott, M, Gresham, R, Nikas, M, Weisbrodt, L, Shehabi, Y, Bass, F, Campbell, M, Stockdale, V, Ankers, S, O'Connor, A, Potter, J, Totaro, R, Rajbhandari, D, Dhiacou, V, Jovanovska, A, Munster, F, Nair, P, Breeding, J, Burns, C, Banerjee, A, Morrison, M, Pfeffercorn, C, Ritchie, A, Buhr, H, Eccleston, M, Parke, R, Bell, J, Newby, L, Henderson, S, Mehrtens, J, Kalkoff, M, West, C, Morgan, J, Rudder, L, Sutton, J, Garrett, P, Groves, N, McDonald, S, Jennifer Palmer, A, Joyce, C, Harwood, M, Helyar, J, Mackie, B, Lipman, J, Boots, R, Bertenshaw, C, Deans, R, Fourie, C, Lassig-Smith, M, Flabouris, A, Edwards, J, O'Connor, S, Rivett, J, Turner, A, Field, T, Marsden, K, Mathlin, C, Goldsmith, D, Mercer, I, O'Sullivan, K, Edington, J, Boschert, C, Smith, J, Ihle, B, Graan, M, Ho, S, Botha, J, Fowler, N, McInness, J, Pratt, N, Orford, N, Elderkin, T, Fraser, M, Kinmonth, A, Wright, C, Burton, S, Culhane, C, Galt, P, Rutzou, R, Roberston, M, Barge, D, Caf, T, Howe, B, Low, P, Tobin, A, Holmes, J, Smith, R, Davies, A, Murray, L, Nevill, R, Vallance, S, Varley, S, White, V, French, C, Little, L, Raunow, H, Blythe, D, Palermo, A, Dobb, G, Boardman, M, Chamberlain, J, Gould, A, McEntaggart, G, Perryman, S & Thomas, L 2014, 'Calorie intake and patient outcomes in severe acute kidney injury: Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial', Critical Care, vol. 18, no. 2, R45, pp. 1-11. https://doi.org/10.1186/cc13767

Calorie intake and patient outcomes in severe acute kidney injury : Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial. / Bellomo, Rinaldo; Cass, Alan; Cole, Louise; Finfer, Simon; Gallagher, Martin; Lee, Joanne; Lo, Serigne; McArthur, Colin; McGuinness, Shay; Myburgh, John; Norton, Robyn; Scheinkestel, Carlos; Mitchell, Imogen; Ashley, Rebecca; Gissane, Jelena; Malchukova, Katya; Ranse, Jamie; Raza, Asif; Nand, Kiran; Sara, Treena; Millis, David; Tan, Jeff; Wong, Helen; Harrigan, Peter; Crowfoot, Elise; Hardie, Miranda; Bhonagiri, Deepak; Micallef, Sharon; Brieva, Jorge; Lintott, Melissa; Gresham, Rebecca; Nikas, Maria; Weisbrodt, Leonie; Shehabi, Yahya; Bass, Frances; Campbell, Michelle; Stockdale, Victoria; Ankers, Susan; O'Connor, Anne; Potter, Julie; Totaro, Richard; Rajbhandari, Dorrilyn; Dhiacou, Vanessa; Jovanovska, Alina; Munster, Francesca; Nair, Priya; Breeding, Jeff; Burns, Claire; Banerjee, Ashoke; Morrison, Maridy; Pfeffercorn, Caroline; Ritchie, Anne; Buhr, Heidi; Eccleston, Michelle; Parke, Rachael; Bell, Jeanette; Newby, Lynette; Henderson, Seton; Mehrtens, Jan; Kalkoff, Michael; West, Cathy; Morgan, John; Rudder, Lorraine; Sutton, Joanne; Garrett, Peter; Groves, Nicole; McDonald, Shona; Jennifer Palmer, and; Joyce, Chris; Harwood, Meg; Helyar, Jean; Mackie, Benjamin; Lipman, Jeff; Boots, Robert; Bertenshaw, Claire; Deans, Renae; Fourie, Cheryl; Lassig-Smith, Melissa; Flabouris, Arthas; Edwards, Jason; O'Connor, Stephanie; Rivett, Justine; Turner, Andrew; Field, Tanya; Marsden, Kathryn; Mathlin, Claire; Goldsmith, Donna; Mercer, Inga; O'Sullivan, Kim; Edington, John; Boschert, Catherine; Smith, Julie; Ihle, Benno; Graan, Michael; Ho, Samuel; Botha, John; Fowler, Nina; McInness, Jodi; Pratt, Naomi; Orford, Neil; Elderkin, Tania; Fraser, Melissa; Kinmonth, Anne; Wright, Christopher; Burton, Sue; Culhane, Carly; Galt, Pauline; Rutzou, Rebecca; Roberston, Megan; Barge, Deborah; Caf, Tania; Howe, Belinda; Low, Patzy; Tobin, Antony; Holmes, Jennifer; Smith, Roger; Davies, Andrew; Murray, Lynne; Nevill, Rachael; Vallance, Shirley; Varley, Sue; White, Vickie; French, Craig; Little, Lorraine; Raunow, Heike; Blythe, David; Palermo, Anna; Dobb, Geoff; Boardman, Melanie; Chamberlain, Jenny; Gould, Andree; McEntaggart, Geraldine; Perryman, Samantha; Thomas, Linda.

In: Critical Care, Vol. 18, No. 2, R45, 2014, p. 1-11.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Calorie intake and patient outcomes in severe acute kidney injury

T2 - Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial

AU - Bellomo, Rinaldo

AU - Cass, Alan

AU - Cole, Louise

AU - Finfer, Simon

AU - Gallagher, Martin

AU - Lee, Joanne

AU - Lo, Serigne

AU - McArthur, Colin

AU - McGuinness, Shay

AU - Myburgh, John

AU - Norton, Robyn

AU - Scheinkestel, Carlos

AU - Mitchell, Imogen

AU - Ashley, Rebecca

AU - Gissane, Jelena

AU - Malchukova, Katya

AU - Ranse, Jamie

AU - Raza, Asif

AU - Nand, Kiran

AU - Sara, Treena

AU - Millis, David

AU - Tan, Jeff

AU - Wong, Helen

AU - Harrigan, Peter

AU - Crowfoot, Elise

AU - Hardie, Miranda

AU - Bhonagiri, Deepak

AU - Micallef, Sharon

AU - Brieva, Jorge

AU - Lintott, Melissa

AU - Gresham, Rebecca

AU - Nikas, Maria

AU - Weisbrodt, Leonie

AU - Shehabi, Yahya

AU - Bass, Frances

AU - Campbell, Michelle

AU - Stockdale, Victoria

AU - Ankers, Susan

AU - O'Connor, Anne

AU - Potter, Julie

AU - Totaro, Richard

AU - Rajbhandari, Dorrilyn

AU - Dhiacou, Vanessa

AU - Jovanovska, Alina

AU - Munster, Francesca

AU - Nair, Priya

AU - Breeding, Jeff

AU - Burns, Claire

AU - Banerjee, Ashoke

AU - Morrison, Maridy

AU - Pfeffercorn, Caroline

AU - Ritchie, Anne

AU - Buhr, Heidi

AU - Eccleston, Michelle

AU - Parke, Rachael

AU - Bell, Jeanette

AU - Newby, Lynette

AU - Henderson, Seton

AU - Mehrtens, Jan

AU - Kalkoff, Michael

AU - West, Cathy

AU - Morgan, John

AU - Rudder, Lorraine

AU - Sutton, Joanne

AU - Garrett, Peter

AU - Groves, Nicole

AU - McDonald, Shona

AU - Jennifer Palmer, and

AU - Joyce, Chris

AU - Harwood, Meg

AU - Helyar, Jean

AU - Mackie, Benjamin

AU - Lipman, Jeff

AU - Boots, Robert

AU - Bertenshaw, Claire

AU - Deans, Renae

AU - Fourie, Cheryl

AU - Lassig-Smith, Melissa

AU - Flabouris, Arthas

AU - Edwards, Jason

AU - O'Connor, Stephanie

AU - Rivett, Justine

AU - Turner, Andrew

AU - Field, Tanya

AU - Marsden, Kathryn

AU - Mathlin, Claire

AU - Goldsmith, Donna

AU - Mercer, Inga

AU - O'Sullivan, Kim

AU - Edington, John

AU - Boschert, Catherine

AU - Smith, Julie

AU - Ihle, Benno

AU - Graan, Michael

AU - Ho, Samuel

AU - Botha, John

AU - Fowler, Nina

AU - McInness, Jodi

AU - Pratt, Naomi

AU - Orford, Neil

AU - Elderkin, Tania

AU - Fraser, Melissa

AU - Kinmonth, Anne

AU - Wright, Christopher

AU - Burton, Sue

AU - Culhane, Carly

AU - Galt, Pauline

AU - Rutzou, Rebecca

AU - Roberston, Megan

AU - Barge, Deborah

AU - Caf, Tania

AU - Howe, Belinda

AU - Low, Patzy

AU - Tobin, Antony

AU - Holmes, Jennifer

AU - Smith, Roger

AU - Davies, Andrew

AU - Murray, Lynne

AU - Nevill, Rachael

AU - Vallance, Shirley

AU - Varley, Sue

AU - White, Vickie

AU - French, Craig

AU - Little, Lorraine

AU - Raunow, Heike

AU - Blythe, David

AU - Palermo, Anna

AU - Dobb, Geoff

AU - Boardman, Melanie

AU - Chamberlain, Jenny

AU - Gould, Andree

AU - McEntaggart, Geraldine

AU - Perryman, Samantha

AU - Thomas, Linda

PY - 2014

Y1 - 2014

N2 - Introduction: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes.Methods: We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models.Results: Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling.Conclusions: In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes.

AB - Introduction: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes.Methods: We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models.Results: Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling.Conclusions: In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes.

UR - http://www.scopus.com/inward/record.url?scp=84897423624&partnerID=8YFLogxK

U2 - 10.1186/cc13767

DO - 10.1186/cc13767

M3 - Article

VL - 18

SP - 1

EP - 11

JO - Critical Care

JF - Critical Care

SN - 1364-8535

IS - 2

M1 - R45

ER -