Nutrition in perioperative patients with kidney failure

The nutritional status of perioperative patients with acute kidney injury (AKI) is often impaired and an important determinant of morbidity and mortality. In addition to well-described imbalances in electrolyte, acid-base, and volume status, AKI also induces alterations in protein, carbohydrate, and lipid metabolism. Hospitalization, especially when associated with critical illness, also reduces appetite and impairs adequate nutrient intake. This adverse combination predisposes patients to serious nutritional deficits, muscle wasting, weakness, and delayed recovery. Adequately designed and powered studies examining the optimal approach to metabolic and nutritional support in perioperative patients with AKI are scarce, and current guidelines for nutritional support are based on expert opinion. The following chapter will provide an overview of the key perturbations observed in substrate and energy metabolism, the underlying pathophysiologic mechanisms, and the debates surrounding the provision of nutritional and metabolic support in perioperative patients with AKI.