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Purpose <p>The optimal intake of artificial nutrition in critically ill patients remains unclear. While calorie and protein intakes affect glomerular function in patients with chronic kidney disease, their relation to renal function at the acute phase of intensive care is insufficiently documented. We aimed to study associations of a low-calorie and low-protein diet with renal outcomes in critically ill patients.</p> Methods <p>This post hoc analysis of the NUTRIREA-3 randomized-controlled trial included 3036 mechanically ventilated patients with shock. Calorie and protein intakes during the first 7 days were either low (6 kcal/kg and 0.2–0.4 g protein/kg/d) or standard (25 kcal/kg and 1.0–1.3 g protein/kg/d). The primary outcome was the incidence of acute kidney disease (AKD) during the ICU stay (up to ICU discharge or day 90 after inclusion, whichever occurred first).</p> Results <p>AKD during the ICU stay occurred in 669 (44.6%) low-group patients and 691&#xa0;(46.1%) standard-group patients (hazard ratio, 0.97; 95% CI 0.88–1.07; <i>P</i>&#xa0;=&#xa0;0.53). The highest urea level and the urea level at ICU discharge were significantly lower in the low group (<i>P</i>&#xa0;=&#xa0;0.002). No differences were found for renal replacement therapy requirements or other renal outcomes. The results were similar in patients with early kidney dysfunction, severe organ failures, or end-stage chronic kidney disease.</p> Conclusion <p>In critically ill patients with shock, early low-calorie and low-protein nutrition for 7 days was not associated with worse renal outcomes or mortality compared to standard feeding, even in patients with preexisting renal dysfunction.</p> Visual abstract <p></p>

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Low versus standard calorie and protein feeding and renal dysfunction in ventilated adults with shock: a NUTRIREA-3 post hoc analysis

  • 期刊论文

  • 发表日期：

    2026年4月16日

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  • Maxime Schleef,
  • Valentin Mayet,
  • Amélie Le Gouge,
  • Julio Badie,
  • Louis Chauvelot,
  • Jérôme Devaquet,
  • Samir Jaber,
  • Julien Jabot,
  • Fabien Lambiotte,
  • Benjamin Madeux,
  • Clara Vigneron,
  • Didier Thévenin,
  • Saad Nseir,
  • Gaetan Plantefeve,
  • Jean-Pierre Quenot,
  • Jean-Philippe Rigaud,
  • Jean-Etienne Herbrecht,
  • Bertrand Souweine,
  • Patrice Tirot,
  • Isabelle Vinatier,
  • Jean Reignier,
  • Laurent Argaud,
  • Jean-Baptiste Lascarrou,
  • Diane Maugars,
  • Gaëtan Plantefève,
  • Damien Contou,
  • Olivier Pajot,
  • Cécile Le Parco,
  • Jean-Paul Mira,
  • Paul Jaubert,
  • Nathalie Marin,
  • Laurent Argaud,
  • Martin Cour,
  • Neven Stevic,
  • Marion Provent,
  • Pierre Asfar,
  • Satar Mortaza,
  • Marc Pierrot,
  • Vincent Souday,
  • Marie Lemerle,
  • Nadia Aissaoui,
  • Julio Badie,
  • Sylvain Malfroy,
  • Fernando Berdaguer Ferrari,
  • Nicolae-Vlad Botoc,
  • Laurent Brisard,
  • Bertrand Rozec,
  • Laurence Pacaud,
  • Hoang-Nam Bui,
  • Didier Gruson,
  • Charline Sazio,
  • Suzanne Champion,
  • Rémi Coudroy,
  • Florence Boissier,
  • Anne Veinstein,
  • Louis Chauvelot,
  • Loredana Baboi,
  • Jean-Christophe Richard,
  • Hodane Yonis,
  • Alain Combes,
  • Loïc Le Guennec,
  • Lucie Lefevre,
  • Juliette Chommeloux,
  • Guillaume Hékimian,
  • Michael Darmon,
  • Virginie Lemiale,
  • Eric Mariotte,
  • Sandrine Valade,
  • Vincent Das,
  • Joanna Tirolien,
  • Matthieu Debarre,
  • Agathe Delbove,
  • Yannick Fedun,
  • Sébastien Bigot,
  • Jerôme Devaquet,
  • Charles Cerf,
  • Guillaume Tachon,
  • Louis-Marie Dumont,
  • Olivier Gontier,
  • Samuel Groyer,
  • Jérôme Roustan,
  • Sylvie Vimeux,
  • Michel Bonnivard,
  • Laurent Guérin,
  • Nadia Anguel,
  • David Osman,
  • Bertrand Guidet,
  • Yannick Hourmant,
  • Karim Asehnoune,
  • Antoine Roquilly,
  • Fouad Belafia,
  • Matthieu Conseil,
  • Moussa Cisse,
  • Lambiotte Fabien,
  • Bouras Chaouki,
  • Fodil Hannane,
  • Christophe Leroy,
  • Anthéa Loïez,
  • Rémi Espenel,
  • Margot Chabanon,
  • Philippe Letocart,
  • Christine Brasse,
  • Sebastien Ena,
  • Arnaud Delahaye,
  • Jeremy Castanera,
  • Thiery Dulac,
  • Philippe Petua,
  • Julien Maizel,
  • Yoann Zerbib,
  • Clement Brault,
  • Olivier Martinet,
  • Frédéric Martino,
  • Régine Richard,
  • Djillali Annane,
  • Rania Bounab,
  • Nicholas Heming,
  • Virginie Maxime,
  • Emmanuelle Mercier,
  • Mai-Anh Nay,
  • Thierry Boulain,
  • Sophie Jacquier,
  • Grégoire Muller,
  • Saad Nseir,
  • Raphaël Favory,
  • Sébastien Preau,
  • Julien Poissy,
  • Johanna Oziel,
  • Alexandre Massri,
  • Floriane Lissonde,
  • Marie Vaissiere,
  • Gaël Piton,
  • Hadrien Winiszewski,
  • Thibault Vieille,
  • Jean-Pierre Quenot,
  • Marine Jacquier,
  • Marie Labruyère,
  • Pascal Andreu,
  • Florian Reizine,
  • Jean-Marc Tadié,
  • Anne Renault,
  • Laetitia Bodenes,
  • Jack Richecoeur,
  • Danièle Combaux,
  • David Luis,
  • Fabienne Huysman,
  • Jean-Philippe Rigaud,
  • Antoine Marchalot,
  • Cécile Lafosse,
  • Christelle Bigot,
  • Françis Schneider,
  • Raphaël Clere-Jehl,
  • Christophe Cracco,
  • David Schnell,
  • Daniel Silva,
  • Jérôme Aboad,
  • Michel Sirodot,
  • David Bougon,
  • Etienne Escudier,
  • Marion Lebouc,
  • Elisabeth Coupez,
  • Claire Dupuis,
  • Fabienne Tamion,
  • Gregoire Jolly,
  • Zoé Demailly,
  • Nicolas Terzi,
  • Louis-Marie Galerneau,
  • Amel Refes,
  • Pierre Nicolas,
  • Olivier Nigeon,
  • Guillaume Thiéry,
  • Nathalie Thieulot-Rolin,
  • Jonathan Chelly,
  • Franck Pourcine,
  • Ly Van Vong,
  • Jean-François Timsit,
  • Sonia Abid,
  • Étienne de Montmollin,
  • Romain Sonneville,
  • François Tinturier,
  • Christophe Guitton,
  • Nicolas Chudeau,
  • Mickaël Landais,
  • Thierry Vanderlinden,
  • Vincent Pages,
  • Isabelle Vinatier,
  • Angélique Deschamps,
  • Natacha Maquigneau,
  • Christophe Vinsonneau,
  • Caroline Sejourne,
  • Imen Rahmani,
  • Ghada Sboui,
  • Sebastian Voicu,
  • Bruno Megarbane,
  • Nicolas Deye,
  • Isabelle Malissin

摘要

Purpose

The optimal intake of artificial nutrition in critically ill patients remains unclear. While calorie and protein intakes affect glomerular function in patients with chronic kidney disease, their relation to renal function at the acute phase of intensive care is insufficiently documented. We aimed to study associations of a low-calorie and low-protein diet with renal outcomes in critically ill patients.

Methods

This post hoc analysis of the NUTRIREA-3 randomized-controlled trial included 3036 mechanically ventilated patients with shock. Calorie and protein intakes during the first 7 days were either low (6 kcal/kg and 0.2–0.4 g protein/kg/d) or standard (25 kcal/kg and 1.0–1.3 g protein/kg/d). The primary outcome was the incidence of acute kidney disease (AKD) during the ICU stay (up to ICU discharge or day 90 after inclusion, whichever occurred first).

Results

AKD during the ICU stay occurred in 669 (44.6%) low-group patients and 691 (46.1%) standard-group patients (hazard ratio, 0.97; 95% CI 0.88–1.07; P = 0.53). The highest urea level and the urea level at ICU discharge were significantly lower in the low group (P = 0.002). No differences were found for renal replacement therapy requirements or other renal outcomes. The results were similar in patients with early kidney dysfunction, severe organ failures, or end-stage chronic kidney disease.

Conclusion

In critically ill patients with shock, early low-calorie and low-protein nutrition for 7 days was not associated with worse renal outcomes or mortality compared to standard feeding, even in patients with preexisting renal dysfunction.

Visual abstract