Micronutrients in critically ill patients with severe acute kidney injury \u2013 a prospective study

Marlies Ostermann,Dominic J Harrington,Charles Turner,Neil Dalton,Janet Peacock,David Card,Jennifer Summers,Roy Sherwood,Danielle E Bear,Katie Lei

doi:10.1038/s41598-020-58115-2

Abstract

Malnutrition is common in patients with acute kidney injury (AKI) and the risk of mortality is high, especially if renal replacement therapy is needed. Between April 2013 through April 2014, we recruited critically ill adult patients (≥18 years) with severe AKI in two University hospitals in London, UK, and measured serial plasma concentrations of vitamin B1, B6, B12, C and D, folate, selenium, zinc, copper, iron, carnitine and 22 amino acids for six consecutive days. In patients receiving continuous renal replacement therapy (CRRT), the concentrations of the same nutrients in the effluent were also determined. CRRT patients (n = 31) had lower plasma concentrations of citrulline, glutamic acid and carnitine at 24 hrs after enrolment and significantly lower plasma glutamic acid concentrations (74.4 versus 98.2 μmol/L) at day 6 compared to non-CRRT patients (n = 24). All amino acids, trace elements, vitamin C and folate were detectable in effluent fluid. In >30% of CRRT and non-CRRT patients, the plasma nutrient concentrations of zinc, iron, selenium, vitamin D3, vitamin C, trytophan, taurine, histidine and hydroxyproline were below the reference range throughout the 6-day period. In conclusion, altered micronutrient status is common in patients with severe AKI regardless of treatment with CRRT.

Highlights

Malnutrition is common in patients with acute kidney injury (AKI) and the risk of mortality is high, especially if renal replacement therapy is needed
Our study confirms that the majority of critically ill patients with AKI had an altered micronutrient status with a large proportion of patients having nutrient concentrations below the reference range, irrespective of continuous renal replacement therapy (CRRT)
With the exception of glutamic acid, there were no significant differences in plasma nutrient concentrations between the CRRT and non-CRRT group during a six-day observational period

Summary

Introduction

Malnutrition is common in patients with acute kidney injury (AKI) and the risk of mortality is high, especially if renal replacement therapy is needed. A recent study showed that 80% of patients on CRRT had below-normal levels of at least one micronutrient i.e. thiamine, pyridoxine, ascorbic acid, folate, zinc or copper[13]. It is unclear whether these alterations of nutrient status contribute to the poor outcomes of patients with AKI. (i) To perform serial measurements of plasma concentrations of amino acids, trace elements and vitamins for up to 6 days in critically ill patients with severe AKI and to compare CRRT patients with non-CRRT

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Conclusion