PD258 - NITROGEN BALANCE AND MORTALITY IN ACUTE KIDNEY INJURY PATIENTS IN ICU.

PD258

NITROGEN BALANCE AND MORTALITY IN ACUTE KIDNEY INJURY PATIENTS IN ICU.

M. D. S. Dorna^1,*, I. B. Magrini², R. F. D. C. Alves Jr², W. Zamoner², D. Ponce²

¹Hospital das Clinicas of Botucatu Medical School, ²Internal Medicine, Botucatu Medical School of State University of Sao Paulo, Botucatu, Brazil

Rationale: In intensive care units, catabolic state, monitored through nitrogen balance (NB), helps guide protein prescription. This study evaluated the association between BN, urea nitrogen appearance(UNA) and mortality  in patients with dialysis-requiring AKI.

Methods: A retrospective, observational study was conducted with patients (>18 years old) diagnosed with KDIGO stage III undergoing acute renal replacement therapy. Patients receiving oral feeding or prior transplantation were excluded. Protein intake, UNA and NB were assessed at two moments: initial nutritional assessment (1) and reassessment (2) after 1 or 2 weeks and correlated with mortality.

Results: A total of 56 individuals were evaluated (63±13.9 years,71.4% male). Prevalent comorbidities included hypertension (55.3%) and diabetes (30.3%), with predominantly septic-ischemic etiology (53.5%).  Hemodialysis was used in 94.6% subjects and the mortality of 67.8%. Mean protein prescription was 1.5g/Kg. At first assessment BN1 -4.67g/N (1,13 - -18.5); UNA1 18.92g/N (12.69 – 30.5). and then BN2 -6.85g/N (2.93 - -12.4); UNA2 21.51g/N (8.40 – 25.25). There were no initial diferences in protein intake, BN or UNA between outcomes. Groups differed significantly regarding the Liano prognostic index (0.48±0.28vs.0.72±0.18 p=0.003). In moment 2, a trend toward higher UNA and a more negative NB was observed among patients who died(20.43±10.18vs14.28±11.16p=0.064and-6.84±12.45vs1.99±9.51p=0.081).

Conclusion: Protein prescription followed current recommendations. After one week there was a trend suggesting that a more negative BN and a higher UNA were associated with increased mortality. Although statistical significance was limited by sample size, the data reinforce the importance of adjusting protein intake based on NB to reduce proteolysis and muscle mass loss in critically ill patients. Conflict of Interest Disclosure: Only Dr Welder Zamoner, speaker of AstraZeneca.

Disclosure of Interest: M. Dorna: None declared, I. Magrini: None declared, R. Alves Jr: None declared, W. Zamoner Speakers Bureau of: AstraZeneca, D. Ponce: None declared