The following is a summary of “Impact of higher protein dosing on outcomes in critically ill patients with acute kidney injury: a post hoc analysis of the EFFORT protein trial,” published in the October 2023 issue of Critical Care by Stoppe et al.
Current guidelines recommend high-dose protein in critically ill patients, but the EFFORT Protein trial showed no benefit, and the effects in patients with acute kidney injury (AKI) are unclear. Researchers started a retrospective study to evaluate the effects of high-dose protein in critically ill patients with AKI of different stages.
They conducted a post hoc analysis on the EFFORT Protein trial, examining the impact of a high protein dose (≥ 2.2 g/kg body weight/day) compared to a usual protein dose (≤ 1.2 g/kg body weight/day) on the time-to-discharge alive from the hospital (TTDA) and 60-day mortality, as well as within various subgroups among critically ill patients with AKI as per the Kidney Disease Improving Global Outcomes (KDIGO) criteria within seven days of ICU admission, exploring the links between protein dose and the incidence and duration of kidney replacement therapy (KRT).
The results showed 1,329 patients randomized, 312 developed AKI, and were part of this analysis (163 in the high protein dose group and 149 in the usual protein dose group). High protein intake was linked to a slower time-to-discharge alive from the hospital (TTDA) (with an HR of 0.5, 95% CI 0.4–0.8) and increased 60-day mortality (with a RR of 1.4, 95% CI 1.1–1.8). Effect modification wasn’t statistically significant in any subgroup, and no subgroup showed a benefit with higher protein intake, although the adverse effects of a higher protein target appeared to lessen in KRT patients. Protein dosage had no significant link to AKI and KRT incidence or KRT duration.
They concluded that high protein dosing may worsen outcomes in critically ill patients with AKI, regardless of AKI stage.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04663-8