Early administration of high protein for critically ill patients with acute kidney injury?

Table 1 Current clinical practice guidelines on protein requirement in patients with acute kidney injury (AKI)

Guideline	Year	Patients	Recommendation	Quality of evidence
ASPEN/SCCM[3]	2016	ICU patients with AKI not on hemodialysis or CRRT	Follow the standard ICU recommendations for protein (1.2–2 g/kg actual BW per day)	Expert opinion^a
ASPEN/SCCM[3]	2016	ICU patients on hemodialysis or CRRT	Increased protein, up to a maximum of 2.5 g/kg per day	Very low^a
ESPEN[2]	2021	Hospitalized patient with AKI, AKI on CKD, CKD, with acute/ critical illness, not on KRT	Start with 1 g/kg BW per day, and gradually increase up to 1.3 g/kg BW per day if tolerated^b	Grade of recommendation 0^a
		Critically ill patients with AKI or AKI on CKD or CKD with KF on conventional intermittent KRT	1.3 to 1.5 g/kg BW per day^b	Grade of recommendation 0^a
		Critically ill patients with AKI or AKI on CKD or CKD with KF on CKRT or PIKRT	1.5 g/kg BW per day up to 1.7 g/kg BW per day^b	Grade of recommendation 0, Consensus (82.6% agreement)^a

^aAs defined by the authors of the guidelines
^bPre-hospitalization body weight or usual body weight may be preferred over the ideal body weight. Actual body weight should not be considered for a protein prescription, as per the ESPEN guidelines
AKI: acute kidney injury, BW: body weight, CKD: chronic kidney disease, KF: kidney failure, CRRT/CKRT: continuous renal/kideny replacement therapy, PIKRT: Prolonged Intermittent Kidney Replacement

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