Nutritional Therapy In Acute Kidney Injury

Jai Prakash

Professor and Head, Department of Nephrology, Banaras Hindu University, Institute of Medical Sciences, Varanasi 221005


Acute kidney injury (AKI) can be defined as abrupt decrease in kidney function within 48 hours in the presence of at least one of the modified KDIGO 2012 criteria

  1. Increase or decrease in serum creatinine >0.3mg/dl from reference creatinine*.

  2. Increase or decrease in serum creatinine >50% from reference creatinine*.

  3. Urine output<400ml/day in adult.

Most recent serum creatinine available in the last 12 months before presenting event is taken as reference creatinine. AKI is rarely an isolated disease process and is most often a complication of sepsis, trauma, or surgery and usually associated with multiple organ failure in the intensive care unit. Patients with AKI, especially in the ICU are at risk of protein energy malnutrition, which play a major negative prognostic factor in this clinical setting. The primary goals of nutrition support in AKI should be aimed at counteracting and attenuating the negative effects of both catabolism and hyper metabolism associated with critical illness on lean body mass, since AKI is seen in a highly heterogeneous group of subjects with varying nutrient needs. Therefore it is essential to assess the nutritional requirements frequently and carefully integrated with RRT, taking into account both the peculiar metabolic derangements/ complications of the acute uraemic state and the effects of the RRT itself on nutritional balance. The Table.I shows various factors contributing to malnutrition in acute renal failure.

Metabolic Alterations in AKI:

The energy metabolism and its requirement, is altered in patients with AKI. The basic determinants of energy expenditure in patients with AKI are the underlying cause rather than the acute uraemic state. In patients with uncomplicated AKI with the controlled uraemia by dialysis, there is little change in energy metabolism. The average

Table 1. Factors Contributing To Malnutrition In Acute Renal Failure




Table 4 Nutritional Requirement In AKI Non-protein calories: 25Kcal/kg/day

Carbohydrate: 5.0gm/kg/day

*Fat: 0.8-1.2 gm/g/day


Protein (EAA and NEAA):

Group 1 : 0.8gm/kg/day Group 2 : l.O-l.5gm/kg/day Group 3 : 1.5-2.0 gm/kg/day

* Nearly 30-35% of total non-protein energy should come from fat.

EAA: Essential amino acid; NEEA: Nonessential amino acid.

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