Nutrition in Sepsis, AKI, and CRRT

Nutrition management for critically ill patients poses a complex challenge with the potential for both benefits and risks, contingent upon thorough patient assessment, the type and timing of nutrition provided, consistent monitoring, and frequent reevaluations. It is imperative to regularly assess the nutritional status and dietary plans, especially for patients with extended hospitalization. In the case of critically ill patients with sepsis and acute kidney injury undergoing continuous renal replacement therapy, there are significant impacts on the patient’s baseline metabolism, the removal of both toxic and nontoxic substances, and the elimination of proteins, free amino acids, vitamins, and trace elements. Evaluating the nutritional needs of critically ill patients receiving continuous renal replacement therapy is notably challenging, as there is currently no available tool with sufficient sensitivity for standard usage. Enteral nutrition can be initiated within the first 24–48 h of admission, while full nutritional support should commence following the initial phase of conservative feeding during the acute illness period. Determining the optimal timing for full enteral nutrition initiation remains an unresolved issue. In cases where enteral nutrition is not viable, parenteral nutrition can be considered, provided there are no contraindications. For septic patients with acute kidney injury undergoing continuous renal replacement therapy, special attention must be paid to total protein and amino acid intake, as these losses are most pronounced in this patient group, and inadequate intake is associated with unfavorable outcomes.