Nutrition in patients with acute renal failure.

Acute renal failure (ARF) is a common disease affecting approximately 5% of all hospitalized patients and 10–30% of the patients in intensive care units. The mortality rate is still very high (above 50%), despite advances in the management of critically ill patients and in the renal replacement therapies. Pre-existing or hospital-acquired malnutrition is an important factor contributing to high mortality seen in patients with ARF w1–4x. Nutritional support has, therefore, been accepted as an important part of the management of ARF. During the course of ARF, multiple metabolic changes occur. ARF affects both fluid, electrolyte, acid–base balance and the metabolism of proteins, amino acids, carbohydrates, lipids and energy. The metabolic alterations in ARF patients are determined not only by acute loss of renal function, but also by the type and intensity of renal replacement therapy. Furthermore, the underlying disease plays an important role in the development of metabolic changes w2,4,5x.