Usefulness Of Nutritional Parameters Based On Creatinine Kinetic Model In Predicting Prognosis In Severe Aki Patients Requring Crrt

Abstract

Malnutrition and protein catabolism have been known as important prognostic factors in AKI patient. The purpose of the present study was to evaluate the usefulness of application of creatinine (CKM) and urea kinetic modeling (UKM) based on the mass balance equation during CRRT treatment and their prognostic significance in severe AKI patients. Urea generation rate (UGR; mg/min) and Cr production rate (Pc; mg/day) were calculated by measuring urea and Cr production/removal balance from patients’ serum, the spent dialysate from CRRT and, if any, urine in 50 ICU patients with severe AKI receiving CRRT. Protein catabolic rate (nPCR; g/kg/d) and lean body mass (LBM; kg) were calculated according to the equations; PCR = [(9.35 x UGR)/BW]+0.17, LBM=(0.029xPc)+7.38. Pc was standardized with body weight and converted into Cr Index (CI; mg/kg/d). The impact of these CKM and UKM parameters on the prognosis in addition to conventional subjective global assessment (SGA) and other known traditional prognostic factors was analyzed. Overall survival of the subjects was 35.3%. Non-survivors showed not only significantly higher APACHE II and chronic comorbidities scores but also severely-malnourished state demonstrated by lower serum albumin, BMI, CI, and LBM. It was revealed that independent parameters associated with mortality were poor SGA (C; Hazard ratio 3.5), low CI (<11 mg/kg/d; HR 1.8), and high comorbidities score (≥3; HR 1.9). In conclusion, nutritional state and chronic comorbidities were major factors predicting the clinical outcome of severe AKI patients requiring CRRT. CKM was a simple and useful method in the assessment of nutritional state during CRRT treatment. Low creatinine production reflecting poor nutrition and protein reserve was associated with poor prognosis in severely ill ARF patients.