Trial reportJournal of the American Society of Nephrology : JASN2013
Impact of early parenteral nutrition on metabolism and kidney injury.
Trial report in Journal of the American Society of Nephrology : JASN, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 7 syntheses or guidelines pooled it, 112 citations in OpenAlex.
- Predictive and prognostic performance of urinary albumin-to-creatinine ratio for acute kidney injury: a systematic review and meta-analysis.Scientific reports · 2026Pooled it
- The urea-to-creatinine ratio as an emerging biomarker in critical care: a scoping review and meta-analysis.Critical care (London, England) · 2025Pooled it
- ICU-acquired weakness.Intensive care medicine · 2020Pooled it
- Clinical prediction models for acute kidney injury.Revista Brasileira de terapia intensiva · 2020Pooled it
- The Japanese clinical practice guideline for acute kidney injury 2016.Clinical and experimental nephrology · 2018Guideline
- Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine.Intensive care medicine · 2017Pooled it
- Nutrition support in hospitalised adults at nutritional risk.The Cochrane database of systematic reviews · 2017Pooled it
- Increased ureagenesis revealing metabolic intolerance to enhanced nutrition in the PICU: a secondary analysis of the PEPaNIC RCT.Critical care (London, England) · 2026Trial
- What is the best dialysis regimen for severe AKI to allow kidney function recovery?Clinical kidney journal · 2026Review
- Establishing a nomogram of the risk of in-hospital mortality in children with suspected sepsis and validating the applicability of the Phoenix.BMC pediatrics · 2026Article
- Nutritional and Metabolic Interventions to Prevent and Treat Protein-Energy Wasting in Nondialysis CKD-Narrative Review.Nutrients · 2026Review
- Crosstalk between innate immune signaling pathways and integrated TLR, NLRP3 inflammasome, cGAS-STING, and NF-κB networks in sepsis.Frontiers in cell and developmental biology · 2026Review
- Association Between the Blood Urea Nitrogen-to-Creatinine Ratio Trajectories and Clinical Outcomes in Critically Ill Hemorrhagic Stroke Patients: Insights from MIMIC-IV Database.Journal of clinical medicine · 2025Article
- On how to feed critically ill children in intensive care: A slowly shifting paradigm.Clinical nutrition (Edinburgh, Scotland) · 2025Review
- Early urea-to-creatinine ratio to predict rapid muscle loss in critically ill patients with sepsis: a single-center retrospective observational study.BMC anesthesiology · 2025Observational
- Higher caloric intake through enteral nutrition is associated with lower hospital mortality rates in patients with candidemia and shock in Taiwan.Acute and critical care · 2024Article
- Personalized Nutrition in the Pediatric ICU: Steering the Shift from Acute Stress to Metabolic Recovery and Rehabilitation.Nutrients · 2024Review
- The kidney: the critical organ system for guiding nutrition therapy in the ICU-patient?Critical care (London, England) · 2024Article
- Nutrition in the intensive care unit: from the acute phase to beyond.Intensive care medicine · 2024Review
- Kidney Dysfunction After Traumatic Brain Injury: Pathophysiology and General Management.Neurocritical care · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A poor nutritional state and a caloric deficit associate with increased morbidity and mortality, but a recent multicenter, randomized controlled trial found that early parenteral nutrition to supplement insufficient enteral nutrition increases morbidity in the intensive care unit, including prolonging the duration of renal replacement therapy, compared with withholding parenteral nutrition for 1 week. Whether early versus late parenteral nutrition impacts the incidence and recovery of AKI is unknown. Here, we report a prespecified analysis from this trial, the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The timing of parenteral nutrition did not affect the incidence of AKI, but early initiation seemed to slow renal recovery in patients with stage 2 AKI. Early parenteral nutrition did not affect the time course of creatinine and creatinine clearance but did increase plasma urea, urea/creatinine ratio, and nitrogen excretion beginning on the first day of amino acid infusion. In the group that received late parenteral nutrition, infusing amino acids after the first week also increased ureagenesis. During the first 2 weeks, ureagenesis resulted in net waste of 63% of the extra nitrogen intake from early parenteral nutrition. In conclusion, early parenteral nutrition does not seem to impact AKI incidence, although it may delay recovery in patients with stage 2 AKI. Substantial catabolism of the extra amino acids, which leads to higher levels of plasma urea, might explain the prolonged duration of renal replacement therapy observed with early parenteral nutrition.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.