الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
AKI is a highly complicated clinical disorder that is widely characterized by rapid rate of reduced rate of GFR, demonstrated by a rise in SCrconcentration or oliguria, or both (39). The incidence of AKI is increasing due to predisposing factors (sepsis, nephrotoxins, and hypotension).
Patients who develop AKI, especially in ICU, are at risk of protein–energy malnutrition, which is a major negative prognostic factor in this clinical condition. PEW is characterized by depletion of protein and energy stores and is caused by multiple factors related to chronic kidney disease, acute and chronic comorbidities and by renal replacement therapy itself. Anorexia is central in the pathogenesis of PEW; it is frequently observed in these patients whose protein and energy intakes are typically lower than guidelines recommendations. If untreated, PEW invariably leads to major complications, and may activate a vicious circle with further worsening of nutritional status.
Dietary counseling and nutritional status monitoring play a key role in the prevention and treatment of PEW, since they allow an early identification of high-risk patients, as well as the assessment of the response to nutritional intervention. Different nutritional approaches can be implemented following thorough nutritional counseling.
These are chosen on the basis of patients’ spontaneous dietary intake, severity of PEW and acute comorbidities. Initially, regular encounters with the dietitian allow patients to clarify doubts and strengthen basic concepts on nutrition to improve dietary intake and prevent PEW. When PEW is present, or the patient is at high risk, the clinician may opt for the administration of oral intradialytic or daily supplements, aiming at increasing energy and protein intake, while in selected cases intradialytic parenteral nutrition may be used.
Optimal nutritional management of critically ill patients who present with AKI is paramount. The management of this patient population is probably
Summary and Conclusion
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more complicated than that of chronic care hemodialysis (HD) patients as AKI patients have significant protein catabolism, insulin resistance (abnormal carbohydrate metabolism) and an altered fat metabolism, and AKI patients on continuous renal replacement therapy (RRT) are at greater risk of protein and micronutrient losses. The primary goals of nutritional management of AKI patients are to attenuate protein (muscle) catabolism, and to replace micronutrient losses, specifically folic acid, thiamine, and selenium, while being mindful of the potentially harmful effects of excessive vitamin C and vitamin A in retinol form.
Insufficient protein intake in catabolic AKI patients is associated with an increased mortality risk. A good understanding of the classification of patients with AKI, the types of RRT used in the management of these patients, the specialized macronutrient and micronutrient requirements, and appropriate fluid management is required for the appropriate dietary management of critically ill AKI patients.