ICU中急性肾损伤（AKI）病人营养支持的主要目的在于确保适当的热量，预防组织蛋白和瘦肉组织不必要的浪费，改善组织修复，支持免疫系统，降低病死率。应首选肠内途径，但即便如此，仍然经常需要辅以肠外营养，以满足目标营养的需求。需要特别关注肾脏替代治疗（RRT）对三大营养素和微量营养素的影响以及可能导致并发症的防范。事实上，由于肾脏体液平衡功能的急性丢失，常需要RRT治疗，AKI病人尤其易出现血糖异常、高甘油三酯血症以及体液、酸碱、电解质的失衡。

Nutritional support in critical patients with acute kidney injury        ZHAO Yun-zhao. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, People’s Liberation Army, Medical College of Nanjing University, Nanjing 210002, China
Abstract    Acute kidney injury(AKI) is a frequent complication affecting many ICU patients and is associated with increased morbidity and mortality. AKI often occurs in conjunction with critical illness, which is a hypermetabolic state presenting with hyperglycemia, insulin resistance, hypertriglyceridemia and increased protein catabolism. In addition to addressing above changes, the clinician should evaluate the important nutrition implications of decreased kidney function which include vitamins, electrolytes, minerals, trace elements and the presence and type of renal replacement therapy. Optimal nutrition management in AKI includes providing adequate macronutrient support to correct underlying conditions and prevent ongoing loss, supplementing micronutrients and vitamins during renal replacement therapy, and adjusting electrolyte replacement based on the degree and extent of renal dysfunction.