ABSTRACT
The incidence of ARF occurring in hospitalized patients is about 5% (1,2). A multicenter review of 72,757 patients admitted to trauma intensive care units concluded that the incidence of posttraumatic ARF that required dialysis was only about 1 % (107 per 100,000 trauma center admissions); however, the mortality rate remained high at 57% (3), and this rate has not changed over the past several decades (4). Spumey et al. (5) reviewed the hospital course of 354 consecutive critically ill patients with ARF who required dialysis therapy. Over a 3-year period, 50% of these patients survived to leave the hospital. Twenty-six of the 176 survivors required dialysis support for more than 4 weeks, and of these, 23 (88%) experienced hypotension and 20 (77%) experienced septicemia. Bullock et al. reported that infection was a common complication in patients with ARF and was an important contributing factor in the development of multisystem organ failure and death in these patients (6). Common to all these patients is prolonged hospitalization, with hospital lengths of stay ranging from 20 to 50 days. The stress and tissue injury in these patients induces a hypermetabolic response, and hypercatabolism quickly leads to starvation. Net protein degradation can be extensive with losses of 150-200 g/day or more (7) and is associated with an excellerated rate of rise in serum potassium, phosphorus,
urea, and a fall in serum pH as these substances are released from cells into the extracellular fluid but are not eliminated because of the renal failure. In an effort to curve the hypercatabolism, Willmore and Dudrick were the first to administer TPN to patients with ARF (8). They combined essential amino acids only with hypertonic dextrose and reported a 50% reduction in blood urea nitrogen (BUN) and a reversal of hyperkalemia, hyperphosphatemia, and metabolic acidosis. They concluded that this therapy provided patients the best chance for combating infection and healing wounds.
