Associate Professor Gordon Doig and his team showed that critically ill patients who received better nutrition were less likely to develop kidney injury. These findings represent an important first step towards global practice change and offers the potential to reduce the need for surgery, dialysis and transplantation.
Almost one in three patients who require treatment in an intensive care unit will develop new onset kidney injury during their illness.1
New onset kidney injury is a very serious complication of critical illness, which can result in a patient needing a kidney transplant or can even cause death. Yet, no treatments have been proven to successfully protect critically ill patients from developing kidney injury.
Associate Professor Gordon Doig has focussed on addressing this issue for quite some time. Since 2003 his primary research goal has been to discover ways that enhanced nutrition may improve survival from critical illness or major trauma.
His team conducted the Nephro-Protective Trial to confirm preliminary results reported in their 2008 study, which demonstrated that critically ill patients who received better nutrition might be less likely to develop kidney injury during their critical illness.
“The Nephro-Protective Trial was conducted in 474 critically ill patients treated in 16 intensive care units throughout Australia and New Zealand,” Associate Professor Doig explained.
“We identified patients with two distinct causes of kidney injury: toxic insult from infection or drugs and shock due to trauma or major surgery.
“We found that a diet with more protein protected against kidney injury caused by shock due to trauma or major surgery.
"Kidney injury presents a significant health burden and exacts a considerable toll on social and economic resources."
“In the healthy adult, kidney blood flow and function increases by 25 to 60 per cent for several hours after the consumption of a high protein meal.
“We also found that in patients who do not have any form of kidney injury at the onset of their critical illness, a diet with more protein may reduce the risk of death,” he notes. Associate Professor Doig and his team are thinking big for the outcomes of their research.
“We expect researchers around the world will conduct additional studies to confirm our results and refine our intervention.
“But, the results of this study represent an important first step towards global practice change,” he concluded.
Associate Professor Doig and his team received funding from the Heart Research Foundation and the Cardiovascular Research & Education Fund of the Sydney Medical School Foundation to conduct a 72 patient pilot study focusing on patients undergoing major cardiovascular surgery to determine if protein intake during surgery reduces kidney injury. This has garnered interest in Italy and Australia.
Kidney injury: the facts
More than 60,000 patients become critically ill throughout Australia each year and require treatment in an intensive care unit. Up to 30 per cent of these patients will develop new onset kidney injury during their illness.1 Mild kidney injury results in a longer hospital stay, but for 20 per cent of patients kidney injury is much more severe and may require lifelong dialysis or even result in early death. In fact, ICU patients who develop severe kidney injury that requires dialysis have a six-time increased risk of death.2
1 Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008; 23:1203-10.
2 Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813-8.