Impact of the Nutritional Regimen on Protein Catabolism and Nitrogen Balance in Patients With Acute Renal Failure

ABSTRACT. Background: Patients with acute renal failure are in substantial negative nitrogen balance as a result of their ex-tremely high protein catabolic rates. We prospectively evalu-ated a series of patients with acute renal failure managed with continuous venovenous hemofiltration to determine which nu-tritional and nonnutritional variables might influence protein ca-tabolism and nitrogen balance. Methods: Forty consecutive pa-tients (aged 52 ± 20 years; mean ± SD) were monitored for 357 treatment days (average treatment duration 8.9 ± 8.6 days). All data (including nutritional regimen, laboratory values, APACHE II score, administered blood products, hemofiltration parameters, and medications) were collected daily. Results: For all patients, the mean normalized protein catabolic rate was 1.4 ± 0.5 g/kg per day. The rate did not differ between those who received nu-trition support and those who did not. The net nitrogen defici