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Various nutrition guidelines recommend increased protein supplementation with continuous kidney replacement therapy (CKRT). Recent EFFORT Protein trial, international multicenter single-blinded randomized trial in the intensive care unit supplying usual protein dose vs higher dose over 2.2g/kg/day. Subgroup analysis suggested an interaction between protein dose and patients with acute kidney injury (stage 1–3) and high SOFA score (≥9) upon admission on both time-to-discharge-alive (appendix p 15) and 60-day mortality (appendix p 16), favoring the usual protein dose. However, this harmful effect disappeared in the patient receiving kidney replacement therapy. There is the opinion that more protein is needed in KRT patients, no studies have proven their effectiveness, so studies so far have been collected and analyzed.
This study is a meta-analysis study on the effect of high-dose protein supply on improving mortality in CKRT patients.
One retrospective study, one prospective observational study, and one single-blinded randomized trial were included. The composite outcome was in-hospital mortality. The funnel plot showed well-distributed, not skewed study inclusion. A total of 3,070 patients were included altogether. Higher protein provision showed no survival improvement compared to usual care (odds ratio 0.67, 95% confidence interval 0.45-1.01)
Although it is known that there are many proteins, vitamins and trace elements that are lost through CKRT, we confirmed that increasing protein supply is not effective in improving survival. This interpretation should be prudent. Increasing protein supply in patients with acute kidney disease has an adverse effect on survival, but since the adverse effect has disappeared in patients with KRT, additional research on when, how much, and what form of supply will be appropriate will be needed.