Personalized Parenteral Nutrition in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy: A Comprehensive Framework for Clinical Practice

Critically ill patients receiving continuous renal replacement therapy (CRRT) face distinct nutritional challenges requiring specialized parenteral nutrition (PN) strategies. This review synthesizes current evidence with clinical expertise to provide a comprehensive nutritional framework for this population. Key findings reveal that CRRT significantly impacts nutrient homeostasis through daily losses of amino acids (14–22 g), water-soluble vitamins, and trace elements via the extracorporeal circuit. Results from observational studies demonstrate that higher protein targets (1.8–2.5 g/kg/day) are necessary to achieve positive nitrogen balance, while energy prescriptions must subtract “hidden” calories from citrate anticoagulation (3–4 kcal/mmol) and propofol (1.1 kcal/mL). Clinical outcome data, though primarily observational, indicate that achieving nutritional adequacy correlates with reduced ICU stays (average reduction 2.1–3.4 days), shorter mechanical ventilation duration, and improved functional recovery. Evidence supports that early PN prescription when indicated, coupled with systematic consideration of therapy modality, extracorporeal losses, oral intake capacity, and mobilization status, optimizes nutritional support. We conclude that successful implementation requires: (1) dynamic adjustment based on CRRT parameters, (2) integration with enteral nutrition when feasible, (3) regular metabolic monitoring, (4) multidisciplinary collaboration, and (5) structured protocols. Future research using point-of-care analysis and AI-driven support systems is needed to establish evidence-based guidelines in this specialized population.

• Publication year

  2025

• Venue

  Journal of Personalized Medicine

• Publication date

  2025-11-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.3390/jpm15110545PMID 41295247PMCID 12653799
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Evaluation of amino acid kinetics during low-dose continuous renal replacement therapy in patients with acute kidney injury: a prospective single-center study.

  2025influential reference
• Personalized Nutrition Strategies for Patients in the Intensive Care Unit: A Narrative Review on the Future of Critical Care Nutrition

  2025influential reference
• Parenteral Nutrition in the Critically Ill Adult: A Narrative Review

  2024cited by this paper
• Nutrition support for patients with renal dysfunction in the intensive care unit: A narrative review

  2024influential reference
• The Integration of Radiomics and Artificial Intelligence in Modern Medicine

  2024cited by this paper
• Prevention of complications for hospitalized patients receiving parenteral nutrition: A narrative review.

  2024cited by this paper
• Impact of the prognostic nutritional index on renal replacement therapy–free survival and mortality in patients on continuous renal replacement therapy

  2024cited by this paper
• Nutrition in the intensive care unit: from the acute phase to beyond

  2024cited by this paper
• Micronutrient Losses during Continuous Renal Replacement Therapy

  2023cited by this paper
• Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients

  2023cited by this paper
• How to avoid harm with feeding critically ill patients: a synthesis of viewpoints of a basic scientist, dietitian and intensivist

  2023cited by this paper
• What the clinician needs to know about medical nutrition therapy in critically ill patients in 2023: A narrative review.

  2023cited by this paper
• Role of Fat-Free Mass Index on Amino Acid Loss during CRRT in Critically Ill Patients

  2023cited by this paper
• Metabolic and nutritional aspects in continuous renal replacement therapy

  2023cited by this paper
• Personalized nutrition therapy in critical care: 10 expert recommendations

  2023cited by this paper
• Micronutrient deficiencies in critically ill patients receiving continuous renal replacement therapy.

  2022cited by this paper
• Nutrients and micronutrients at risk during renal replacement therapy: a scoping review

  2021cited by this paper
• Guidelines for the provision of nutrition support therapy in the adult critically Ill patient: American society for parenteral and enteral nutrition.

  2021cited by this paper
• Clearance of micronutrients during continuous renal replacement therapy

  2020cited by this paper
• ESPEN guideline on clinical nutrition in the intensive care unit.

  2019influential reference
• SANRA—a scale for the quality assessment of narrative review articles

  2019influential reference
• Micronutrient and Amino Acid Losses During Renal Replacement Therapy for Acute Kidney Injury

  2019cited by this paper
• Amino Acid Loss during Continuous Venovenous Hemofiltration in Critically Ill Patients

  2019influential reference
• Metabolic Support of the Patient on Continuous Renal Replacement Therapy

  2018cited by this paper
• Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

  2018influential reference
• Supplemental parenteral nutrition versus usual care in critically ill adults: a pilot randomized controlled study

  2018cited by this paper
• Continuous renal replacement therapy: a potential source of calories in the critically ill.

  2017influential reference
• Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group.

  2017influential reference
• Relevance of non-nutritional calories in mechanically ventilated critically ill patients

  2016cited by this paper
• Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials

  2016cited by this paper
• Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults.

  2015cited by this paper
• Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database

  2014cited by this paper
• Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial.

  2013cited by this paper
• Early versus Late Parenteral Nutrition in Critically Ill Adults

  2011cited by this paper
• Nutrition therapy in the critical care setting: What is “best achievable” practice? An international multicenter observational study*

  2010cited by this paper
• Specific nutritional problems in acute kidney injury, treated with non-dialysis and dialytic modalities

  2009influential reference
• Parenteral nutrition in the critically ill patient.

  2009influential reference
• Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

  2009influential reference
• Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial.

  2008cited by this paper
• Total parenteral nutrition in the critically ill patient: a meta-analysis.

  1999cited by this paper
• Amino acid clearances and daily losses in patients with acute renal failure treated by continuous arteriovenous hemodialysis

  1991influential reference
• Total parenteral nutrition in the critically ill patient.

  1986cited by this paper

• No citing papers are available for this paper.