The Effects of Intensive Insulin on Somatic and Visceral Protein Turnover in Acute Kidney Injury (AKI)

Inclusion Criteria:

• Adults ≥ 18 years of age admitted to the intensive care unit

• New onset acute kidney injury (AKI) or AKI superimposed on chronic kidney disease. AKI will be defined as:

  • an abrupt (within 48 hours) sustained increase (>24 hours) in serum creatinine of 2X baseline or
  • a reduction in urine output (documented oliguria of < 0.5 ml/kg/hr for >12 hours)
• Patients will be recruited for the study within 3-5 days following establishment of AKI

Exclusion Criteria:

• Institutionalized patient
• Unable to obtain consent from subject or legally recognized representative
• Pregnancy
• Patients receiving insulin within 12 hours of the study or patients with known diabetes mellitus.
• Patients receiving immunosuppressive medication including steroids (prednisone or equivalent dose ≥ 5 mg PO QD)
• AKI from urinary tract obstruction or a volume responsive pre-renal state.
• Liver Failure, defined as transaminase levels 3 times above the limit of normal or a total Bilirubin greater than 4 mg/dl.
• Evidence of active bleeding, defined as admission for bleeding (ex. GI bleed, ruptured aneurysm, trauma-related) coupled with an explained or unexplained decrease in hemoglobin of >2 points in the past 24 hours, or Hgb<8/Hct<24
• Ongoing myocardial ischemia or heart failure
• Life expectancy < 48 hours
• Patients without existing central venous access
• Hemodynamically unstable patients requiring active pressor titration, defined as an increase in current pressor dose by >20% or addition of a new pressor within 12 hours of initiating the study.
• History of Phenylketonuria (PKU) or other documented inborn errors of metabolism
• Hypokalemia, defined as a serum potassium of <3.0 mg/dl.
• Uncontrolled seizure disorder, defined as having seizure as a reason for admission, ongoing delirium tremens, or having had a seizure within 1 month of the study.