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Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial

Lv C 1 , Zhou L 2 , Zhou Y 3 , Lew CCH 4 , Lee ZY 5 , Hasan MS 6 Show all authors , Li B 1 , Liu Y 2 , Lin J 1 , Mao W 1 , Stoppe C 5 , van Zanten ARH 7 , Li W 1 , Liu Y 3 , Ke L 1 , Chinese Critical Care Nutrition Trials Group (CCCNTG)

Affiliations 

  • 1 Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 22 Hankou Road, Gulou District, Nanjing 210093, China
  • 2 Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Southeast University, 87 Ding Jiaqiao, Gulou District, Nanjing 210009, China
  • 3 Department of Biostatistics, School of Public Health, Southern Medical University, 1023-1063 Shatai South Road, Baiyun District, Guangzhou 510515, China
  • 4 Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore, Singapore 1 Jurong East Street 21, Singapore
  • 5 Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Charitéplatz 1, 10117 Berlin, Germany
  • 6 Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia
  • 7 Department of Intensive Care, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands
Burns Trauma, 2024;12:tkae027.
PMID: 39049866 DOI: 10.1093/burnst/tkae027

Abstract

BACKGROUND: There is controversy over the optimal early protein delivery in critically ill patients with acute kidney injury (AKI). This study aims to evaluate whether the association between early protein delivery and 28-day mortality was impacted by the presence of AKI in critically ill patients.

METHODS: This is a post hoc analysis of data from a multicenter cluster-randomised controlled trial enrolling newly admitted critically ill patients (n = 2772). Participants without chronic kidney disease and with complete data concerning baseline renal function were included in this study. The primary outcome was 28-day mortality. Cox proportional hazards models were used to analyze the association between early protein delivery, reflected by mean protein delivery from day 3-5 after enrollment, 28-day mortality and whether baseline AKI stages interacted with this association.

RESULTS: Overall, 2552 patients were included, among whom 567 (22.2%) had AKI at enrollment (111 stage I, 87 stage II, 369 stage III). Mean early protein delivery was 0.60 ± 0.38 g/kg/day among the study patients. In the overall study cohort, each 0.1 g/kg/day increase in protein delivery was associated with a 5% reduction in 28-day mortality[hazard ratio (HR) = 0.95; 95% confidence interval (CI) 0.92-0.98, p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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