ESPEN 2021 Abstract Submission

Topic: Critical care

Abstract Submission Identifier: ESPEN21-ABS-1594

BIOENERGETIC BALANCE OF CRRT. A POST-HOC ANALYSIS OF THE MECCIAS TRIAL

J. Jonckheer^*, ¹, J. Poelaert ¹, E. De Waele ²

¹intensive care, ²clinical nutrition, universitair ziekenhuis brussel, Jette, Belgium

Rationale: Indirect calorimetry guided nutritional therapy is the gold standard and is associated with lower morbidity and mortality in critically ill patients. Scientific progress has made the use of a metabolic cart possible during CVVH. Non-intentional calories due to citrate, glucose and lactate in dialysis fluids must be taken into account when formulating a caloric prescription. We aimed to evaluate this bioenergetic balance of CVVH and how nutritional therapy should be adapted. 

Methods: This is a post hoc analysis of the prospective MECCIAS trial which analyzed CO₂ removal during low dose CVVH with citrate, high dose CVVH with citrate and low dose CVVH without citrate to conclude a low impact on measured resting energy expenditure (REE). CVVH runs were included in the statistical analysis when effluent dose of glucose and lactate were present. Citrate, glucose and lactate balance were compared respectively during low dose CVVH with citrate (e.g. glucose_c), compared to CVVH during high dose (e.g. glucose_HD) and finally low dose CVVH without citrate (e.g. glucose_- ) with a one way anova.

The caloric load of these non-nutritional calories was compared to the true REE (which takes CO₂ and O₂exchange of CVVH into account).

Results: The mean caloric load of citrate_c was 736±101 Kcal/day,; the setting with citrate_HD delivered 564 ± 75 Kcal/day and citrate_- 0 Kcal/day (p<0,0001 )_. The caloric load of glucose_c was -222±90 Kcal/day compared to glucose_HDof -262±202 Kcal/day and glucose_- of -187± 74 Kcal/day (p=0,584). The caloric load of lactate_c was -16±5 Kcal/day, lactate_HD was -7±27 Kcal/day and lactate_- 3± 15Kcal/day (p=0,032). This resulted in a statistically significant absolute bioenergetic balance (p<0,0001) and difference (in %) of true REE (p=0,001). The [bioenergetic balance]_c was 498±110Kcal/day (range 339 to 681 Kcal/day) or 26±9% (range 14 to 42%) of REE compared to [total caloric balance]_HD of 262±222 Kcal/day or 17±11% of REE and [total caloric balance]_-of -189±77Kcal/day (range -298 to -92Kcal/day) or -13±8 % (range -28 to -5%) of REE. 

Conclusion: Different CVVH settings resulted in different caloric balances ranging from - 28 % up to +42 % of true REE. When formulating a caloric prescription, an individual approach taking the balance of these non-nutritional calories into account seems warranted. During low dose CVVH with citrate, feeding with relative high dose protein formula seems required as CVVH delivers a lot of carbohydrate based calories.  

Disclosure of Interest: None Declared

Keywords: citrate, CRRT, glucose metabolism, indirect calorimetry, lactate