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The role of intravenous glutamine administration in critical care patients with acute kidney injury: a narrative review

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Emergency and Critical Care Medicine 2024年第3期4卷 117-125页

作者： Jonny J. Larasati A.D. Ramadhani b.P. hernowo b.a. Pasiak T.F. Faculty of Medicine Universitas Prima Indonesia Medan Indonesia Department of Internal Medicine Gatot Soebroto Central Army Hospital Dki Jakarta Indonesia Faculty of Medicine of the Jakarta Veteran National Development University Dki Jakarta Indonesia Faculty of Military Medicine Indonesia Defense University West Java Indonesia

The kidneys are complex organs responsible for waste removal and various regulatory functions. Critically ill patients often experience acute kidney injury (AKI). Although renal replacement therapy is used to manage AKI, nutritional therapy is crucial. Glutamine, an amino acid involved in cellular functions, has potential benefits when administered intravenously to critically ill patients. This administration is associated with reduced mortality rates, infectious complications, and hospitalization duration. However, its use in patients with AKI remains controversial. Glutamine is used by various organs, including the kidneys, and its metabolism affects several important pathways. Intravenous glutamine supplementation at specific doses can improve blood marker levels and restore plasma glutamine concentrations. Moreover, this supplementation reduces infections, enhances immune responses, decreases disease severity scores, and reduces complications in critically ill patients. However, caution is advised in patients with multiple organ failure, particularly AKI, as high doses of glutamine may increase mortality rates. Hyperglutaminemia can have adverse effects. Monitoring and appropriate dosing can help to mitigate these risks. Kidneys rely on glutamine for various essential functions. Thus, the use of intravenous glutamine in critically ill patients with AKI remains controversial. Despite its potential benefits in terms of infection reduction, immunomodulation, and improved outcomes, careful consideration of the patient's condition, dosage, and treatment duration is necessary. Further research is needed to establish optimal guidelines for glutamine administration in this patient population. © Wolters Kluwer Health, Inc. All rights reserved.

关键词： Acute kidney injury Critical illness Glutamine Parenteral nutrition

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