临床时讯 ＞ 临床研究
Nutr Clin Pract. 2011 Aug;26(4):434-9.
An essential infusion for an essential organ
Ronald L. Koretz, Department of Medicine, Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342.
Essential amino acid-based parenteral nutrition (PN) was found to be superior to hypertonic dextrose for patients with acute renal failure in a classical randomized trial that was published in 1973. However, subsequent trials were not able to duplicate this finding when this formulation was compared to hypertonic dextrose or to standard amino acid-based PN. As a result, this intervention has not been recommended in various guidelines for the nutrition support of patients with renal failure. However, all of these trials were relatively small, and none of them compared the intervention to a true control group-namely, patients who were not receiving any artificial nutrition. Because no trials have compared any form of artificial nutrition to no nutrition support in patients with acute renal failure, there really is no basis on which to make any level 1 evidence-based recommendation. Furthermore, a close look at all of the trials suggests that the essential amino acid-based formulation may be superior to the other types of intravenous nutrient supplementation to which it was compared. To determine whether this should be offered to patients with acute renal failure, we need data from one or more large, well-designed and executed, low risk of bias randomized trial(s) comparing essential amino acid-based PN to no nutrition therapy.