Short-term consequences of continuous renal replacement therapy on body composition and metabolic status in sepsis

Abstract

Background and objectives: Fluid overload and hypermetabolism frequently occur in sepsis patients in the intensive care unit (ICU) setting. These abnormalities correlate with inflammatory mediators released under stressful conditions. Continuous renal replacement therapy (CRRT) is an extracorporeal life support technology that persistently and stably eliminates overhydration and cytokines. This study investigated the short-term consequence of CRRT on body composition and pattern of energy expenditure.

Methods and study design: We prospectively observed 27 sepsis patients in our ICU treated with CRRT. Bioelectrical impedance analysis and indirect calorimetry were determined at admission and before and after CRRT. All parameters considered to affect body composition and metabolic state with short-term CRRT were recorded. We used correlation analysis to evaluate the relationship between the change of nutritional state and other parameters.

Results: Patients had a decreased total body water load and an improved metabolic pattern, but the nutritional parameters had no significant change between pre- and post-CRRT. Furthermore, we observed the percentage variation of resting energy expenditure (REE) was positively correlated with intracellular water change (r=0.547, p=0.003) and CRRT duration (r=0.515, p=0.006). A negative correlation was found between the percentage variation of REE and dialysate temperature (r=-0.668, p=0.001).

Conclusion: These results suggest that short-term CRRT reduces systemic volume in sepsis patients with overhydration and hypermetabolism, but has no significant impact on acute nutritional status. Meanwhile, CRRT may exert its optimum efficiency when accompanied by other medical practices and support methods.