Acute renal failure (ARF) occurs in 5-7% of all hospitalized patients and is associated with a terrible prognosis. The nutritional status of ARF patients has been proposed to be an important determinant of subsequent morbidity and mortality. While the nutritional hallmark of critically ill patients with ARF is extreme hypercatabolism, malnutrition can also develop due to both inadequate protein and calorie supplementation, and diminished utilization of available nutrients. The long-term objectives of this proposal are to identify specific markers of catabolic stress and malnutrition that best correlate with adverse outcomes, and establish the extent to which negative nitrogen and energy balance contribute to increased morbidity and mortality in ARF patients.
The specific aims are: (1) to examine the utility of specific markers of nutritional status and catabolic stress in assessing the efficacy of nutritional therapy and in predicting outcome in ARF patients; (2) to examine the interrelationship between the etiology of ARF associated with co-morbid conditions and characteristics of renal replacement therapy on the level of catabolism and nutritional parameters in ARF patients; (3) to examine the impact of nitrogen balance on outcome in ARF patients; and (4) to evaluate feasibility of implementing an optimized nutritional assessment and prescription protocol in ARF patients. The research design of this proposal includes a 3 month lead-in phase, a 36 month observational phase (including 9 months of data analysis), followed by a 6 month feasibility phase and a 3 month final analysis phase. A joint data collection instrument will be utilized as part of an Interactive Research Project Grant to collect data on nutritional and outcome parameters in ARF patients. Additional measurements of markers of catabolism, and both biochemical and body composition nutritional parameters, will be made at the principal nutrition sites. The feasibility of implementing an optimized nutritional regimen and measuring the effects on nutritional and metabolic parameters will also be performed.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
1R01DK053413-01A1
Application #
2677949
Study Section
Special Emphasis Panel (ZRG4-ORTH (01))
Project Start
1998-08-01
Project End
2002-07-31
Budget Start
1998-08-01
Budget End
1999-07-31
Support Year
1
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Maine Medical Center
Department
Type
DUNS #
City
Portland
State
ME
Country
United States
Zip Code
04102
Claure-Del Granado, Rolando; Macedo, Etienne; Soroko, Sharon et al. (2014) Anticoagulation, delivered dose and outcomes in CRRT: The program to improve care in acute renal disease (PICARD). Hemodial Int 18:641-9
Claure-Del Granado, Rolando; Macedo, Etienne; Chertow, Glenn M et al. (2012) Toward the optimal dose metric in continuous renal replacement therapy. Int J Artif Organs 35:413-24
Claure-Del Granado, Rolando; Macedo, Etienne; Chertow, Glenn M et al. (2011) Effluent volume in continuous renal replacement therapy overestimates the delivered dose of dialysis. Clin J Am Soc Nephrol 6:467-75
Mehta, Ravindra L; Bouchard, Josée; Soroko, Sharon B et al. (2011) Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease. Intensive Care Med 37:241-8
Bouchard, Josée; Macedo, Etienne; Soroko, Sharon et al. (2010) Comparison of methods for estimating glomerular filtration rate in critically ill patients with acute kidney injury. Nephrol Dial Transplant 25:102-7
Macedo, Etienne; Bouchard, Josee; Soroko, Sharon H et al. (2010) Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care 14:R82
Khosla, Nitin; Soroko, Sharon B; Chertow, Glenn M et al. (2009) Preexisting chronic kidney disease: a potential for improved outcomes from acute kidney injury. Clin J Am Soc Nephrol 4:1914-9
Bouchard, Josée; Soroko, Sharon B; Chertow, Glenn M et al. (2009) Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 76:422-7
Hingorani, Sangeeta; Molitoris, Bruce A; Himmelfarb, Jonathan (2009) Ironing out the pathogenesis of acute kidney injury. Am J Kidney Dis 53:569-71
Liu, Kathleen D; Himmelfarb, Jonathan; Paganini, Emil et al. (2006) Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol 1:915-9

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