Management of Acute Kidney Injury and Chronic Kidney DiseaseManual of Clinical Nutrition Management III- 111 Copyright © 2013 Compass Group, Inc.
depend on the patient’s stress level, acuity level, and nutritional status and should include the energy
obtained from CRRT (2). (Refer to Section II: “Estimation of Energy Expenditures”.)
Protein: The optimal protein intake for patients who have AKI remains controversial and should be
prescribed based on the degree of catabolism and type of renal replacement therapy (2,9). Without dialysis or
catabolism, provide 0.8 to 1.2 g/kg of actual body weight. In the presence of catabolism, provide 1.2 to 1.5
g/kg of actual body weight. CRRT can remove amino acids and proteins; therefore, a minimal protein intake
of 1.5 g/kg of recommended body weight per day is suggested (4,9). If CRRT is frequently used, the protein
requirements may be higher.
Sodium: Sodium intake should be 2,000 to 3,000 mg/day based on the patient’s blood pressure and the
presence of edema. During the diuretic phase, replace sodium losses based on urinary output, edema, renal
replacement therapy, and serum sodium levels.
Potassium: Provide 2,000 to 3,000 mg/day of potassium. During the diuretic phase, replace potassium
losses based on urinary volume, serum and urinary potassium levels, renal replacement therapy, and drug
therapy.
Phosphorus: Provide 8 to 15 mg/kg of phosphorus. Closely monitor the phosphorus levels of patients who
receive renal replacement therapy.
Calcium: Maintain serum levels of calcium within normal ranges. Closely monitor the calcium levels of
patients who receive renal replacement therapy.
Fluids: The daily fluid intake should be 500 mL plus the volume of urine output. The fluid intake also
depends on the serum and urinary sodium level, total fluid output (including urine), and type of dialysis.
Vitamin and mineral supplementation: Individualize supplementation based on laboratory values,
documented deficiencies, and the type of renal replacement therapy. Ensure that the Dietary Reference
Intakes for vitamins and minerals are provided. Patients who receive CRRT must be carefully monitored
because CRRT causes a significant loss of magnesium, calcium, phosphorus, and potassium (2,10). Patients who
have AKI require supplementation of water-soluble vitamins to prevent deficiency caused by renal
replacement therapy losses, inadequate intake, drug-nutrient interactions, and higher needs (2,6). Although
the evidence is limited, the supplementation guidelines in Table III- 30 have been proposed for patients who
have AKI and receive CRRT (specifically continuous venovenous hemofiltration) (4). In addition, critically ill
patients who stay in the intensive care unit for more than 10 days are often deficient in vitamin D and have
increased bone turnover (11). Supplementation of vitamin D in AKI needs further research, because the
mechanism of vitamin D metabolism” is not the same as in end-stage renal disease (11).
Table III- 30 : Vitamin and Mineral Supplementation in AKI Managed with CRRT (2,4)
Vitamin/Mineral Dose
Vitamin K 4 mg/week
Vitamin E 10 IU/day
Niacin 20 mg/day
Thiamin 1.5 mg/day
Riboflavin 1.5-1.7 mg/day
Pantothenic acid (vitamin B 5 ) 5 - 10 mg/day
Vitamin C 60 - 125 mg/day
Biotin 150 - 300 mcg/day
Folic acid 1 mg/day
Vitamin B 12 4 mcg/day
Zinc 20 mg ?a^
Vitamin A Avoid
a The question mark is included in the reference article (4).
Also refer to Section G: “Medical Nutrition Therapy for Chronic Kidney Disease” for information and
nutritional guidelines associated with CRRT.