Critical Care · 19 authors, 14 centres
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This post hoc analysis of a randomized trial compared high versus usual protein dosing in critically ill patients with acute kidney injury (AKI). The central result was that high-dose protein was associated with a slower time to discharge alive and higher 60-day mortality.
This is a post hoc analysis of the EFFORT Protein trial, a multicenter randomized controlled trial. The analysis included 312 critically ill patients who developed acute kidney injury (AKI) as defined by KDIGO criteria. Patients were randomized to receive either high-dose protein (≥ 2.2 g/kg/day) or usual-dose protein (≤ 1.2 g/kg/day). The primary outcome was time-to-discharge alive (TTDA), and a key secondary outcome was 60-day mortality. Results showed that high-dose protein was associated with a slower TTDA (hazard ratio 0.5) and higher 60-day mortality (relative risk 1.4). The harmful association was observed across all AKI stages and was not statistically significant in patients who received kidney replacement therapy (KRT). High-dose protein was not associated with the incidence or duration of KRT. The study's main limitations are its post hoc design, potential for confounding from post-randomization subgroup definitions, and lack of adjustment for multiplicity in subgroup tests. The findings suggest that high protein dosing may be harmful in mechanically ventilated patients with AKI, particularly those not on KRT, and highlight the need to re-evaluate current nutrition guidelines.
