TY  - JOUR
A1  - Stoppe, Christian
A1  - Patel, Jayshil J.
A1  - Zarbock, Alex
A1  - Lee, Zheng-Yii
A1  - Rice, Todd W.
A1  - Mafrici, Bruno
A1  - Wehner, Rebecca
A1  - Chan, Man Hung Manuel
A1  - Lai, Peter Chi Keung
A1  - MacEachern, Kristen
A1  - Myrianthefs, Pavlos
A1  - Tsigou, Evdoxia
A1  - Ortiz-Reyes, Luis
A1  - Jiang, Xuran
A1  - Day, Andrew G.
A1  - Hasan, M. Shahnaz
A1  - Meybohm, Patrick
A1  - Ke, Lu
A1  - Heyland, Daren K.
T1  - The impact of higher protein dosing on outcomes in critically ill patients with acute kidney injury: a post hoc analysis of the EFFORT protein trial
JF  - Critical Care
N2  - Background
Based on low-quality evidence, current nutrition guidelines recommend the delivery of high-dose protein in critically ill patients. The EFFORT Protein trial showed that higher protein dose is not associated with improved outcomes, whereas the effects in critically ill patients who developed acute kidney injury (AKI) need further evaluation. The overall aim is to evaluate the effects of high-dose protein in critically ill patients who developed different stages of AKI.

Methods
In this post hoc analysis of the EFFORT Protein trial, we investigated the effect of high versus usual protein dose (≥ 2.2 vs. ≤ 1.2 g/kg body weight/day) on time-to-discharge alive from the hospital (TTDA) and 60-day mortality and in different subgroups in critically ill patients with AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria within 7 days of ICU admission. The associations of protein dose with incidence and duration of kidney replacement therapy (KRT) were also investigated.

Results
Of the 1329 randomized patients, 312 developed AKI and were included in this analysis (163 in the high and 149 in the usual protein dose group). High protein was associated with a slower time-to-discharge alive from the hospital (TTDA) (hazard ratio 0.5, 95% CI 0.4–0.8) and higher 60-day mortality (relative risk 1.4 (95% CI 1.1–1.8). Effect modification was not statistically significant for any subgroup, and no subgroups suggested a beneficial effect of higher protein, although the harmful effect of higher protein target appeared to disappear in patients who received kidney replacement therapy (KRT). Protein dose was not significantly associated with the incidence of AKI and KRT or duration of KRT.

Conclusions
In critically ill patients with AKI, high protein may be associated with worse outcomes in all AKI stages. Recommendation of higher protein dosing in AKI patients should be carefully re-evaluated to avoid potential harmful effects especially in patients who were not treated with KRT.

Trial registration: This study is registered at ClinicalTrials.gov (NCT03160547) on May 17th 2017.
KW  - acute kidney injury
KW  - critical illness
KW  - nutrition support
KW  - protein
KW  - randomized trial
KW  - registry trial
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357221
VL  - 27
ER  -