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 Patrick Gallagher, Joanne Lee, Serigne Lo, Colin McArthur, Shay McGuinness, John Myburgh, Robyn Norton, Carlos Scheinkestel

Research output: Contribution to journalArticleResearchpeer-review

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
Number of pages11
JournalCritical Care
Volume18
Issue number2
DOIs
Publication statusPublished - 14 Mar 2014
Externally publishedYes

Cite this

@article{54b90713e943430eb31e0b0aa1a48104,
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 Gallagher, {Martin Patrick} and Joanne Lee and Serigne Lo and Colin McArthur and Shay McGuinness and John Myburgh and Robyn Norton and Carlos Scheinkestel",
year = "2014",
month = "3",
day = "14",
doi = "10.1186/cc13767",
language = "English",
volume = "18",
journal = "Critical Care",
issn = "1364-8535",
number = "2",

}

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 Patrick; Lee, Joanne; Lo, Serigne; McArthur, Colin; McGuinness, Shay; Myburgh, John; Norton, Robyn; Scheinkestel, Carlos.

In: Critical Care, Vol. 18, No. 2, R45, 14.03.2014.

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 Patrick

AU - Lee, Joanne

AU - Lo, Serigne

AU - McArthur, Colin

AU - McGuinness, Shay

AU - Myburgh, John

AU - Norton, Robyn

AU - Scheinkestel, Carlos

PY - 2014/3/14

Y1 - 2014/3/14

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://ccforum.com/content/18/2/R45

U2 - 10.1186/cc13767

DO - 10.1186/cc13767

M3 - Article

VL - 18

JO - Critical Care

JF - Critical Care

SN - 1364-8535

IS - 2

M1 - R45

ER -