Zusammenfassung
EINLEITUNG: Der Einfluss einer Eiweiß-reichen Nahrung auf die glomeruläre Filtration ist sowohl beim Gesunden als auch beim chronisch nierenkranken Patienten gut belegt, beim akuten Nierenversagen bei kritisch kranken Patienten jedoch noch nicht untersucht worden. Die vorliegende Studie untersucht daher die Wirkung einer hohen Zufuhr von Aminosäuren auf die glomeruläre Filtrationsrate (GFR) und die N-Bilanz bei kritisch kranken Patienten mit akutem Nierenversagen. METHODEN: Vierzehn kritisch kranke Patienten mit einer Kreatinin-Clearance unter 50 ml/min und erhaltener Diurese über 2000 ml/Tag erhielten 2000 nicht-Protein kcal und 75 g (Gruppe 1) oder 150 g (Gruppe 2) Aminosäuren parenteral pro Tag. Nierenfunktionsparameter, Flüssigkeitsbilanz, Na und N-Bilanz sowie der Bedarf an Furosemid wurden an den Tagen 2, 3 und 4 erhoben. ERGEBNISSE: Die beiden Gruppen waren hinsichtlich Geschlecht, Schweregrad der Erkrankung, und Kreatinin-Clearance vergleichbar, Gruppe 2 allerdings signifikant (p < 0,05) älter. Der BUN stieg nur in der Gruppe 1 und nicht in der Gruppe 2 signifikant an. Die Kreatinin-Clearance blieb in beiden Gruppen unverändert. Gruppe 2 hatte eine signifikant positivere N-Bilanz (−10,5 ± 17 g/Tag 9 versus + 8,3 g/Tag) (p < 0,01), eine geringer positive Flüssigkeitsbilanz (2003 ± 1336 ml versus −2407 ± 1990 ml) und einen geringeren Furosemid-Bedarf (1003 ± 288 mg versus 649 ± 293 mg) (p < 0,05). SCHLUSSFOLGERUNG: Die Gabe hoher Konzentrationen von Aminosäuren als Teil der parenteralen Ernährung verbessert die N-Bilanz, vermindert den Furosemid-Bedarf und führt zu einer günstigeren Flüssigkeitsbilanz bei Patienten mit nicht-oligurischem akuten Nierenversagen.
Summary
INTRODUCTION: The effects of protein-enriched diets on glomerular filtration have been described in normal subjects and in patients with chronic renal failure. In acute renal failure, the effects of administration of high rates of protein on renal function and nitrogen balance have not been studied in critically ill patients. The present study examines the effects of large doses of amino acids on the glomerular filtration rate and nitrogen balance in critically ill patients with acute renal failure. METHODS: Fourteen critically ill patients with a creatinine clearance below 50 ml/min and conserved diuresis above 2,000 ml/day received 2000 non-protein kcal/day and either 75 g (Group1) or 150 g (Group 2) of amino acids parenterally. Renal function tests, fluid balance, sodium and nitrogen balances, and furosemide administration were assessed on day 1 (baseline day when dextrose 5% was administered) and days 2, 3 and 4. RESULTS: The two groups were comparable in terms of severity indices, sex and creatinine clearance. Group 2 was significantly older (p < 0.05). Blood urea nitrogen increased significantly in Group 1 but not in Group 2; creatinine clearance remained unchanged in the two groups. Group 2 patients had a significantly more positive cumulative nitrogen balance (−10.5 ± 17 g/day vs. 9 ± 8.3 g/day) (p < 0.01), less positive fluid balance (2003 ± 1336 ml vs. −2407 ± 1990 ml) and lower furosemide requirement (1003 ± 288 mg vs. 649 ± 293 mg) (p < 0.05). CONCLUSION: A high amino acid regimen administered as a part of parenteral nutrition improves nitrogen balance, reduces furosemide requirements and ameliorates water balance in acute renal failure patients with conserved diuresis.
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Singer, P. High-dose amino acid infusion preserves diuresis and improves nitrogen balance in non-oliguric acute renal failure. Wien Klin Wochenschr 119, 218–222 (2007). https://doi.org/10.1007/s00508-007-0794-3
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DOI: https://doi.org/10.1007/s00508-007-0794-3