Trial reportCritical care (London, England)2023
The impact of higher protein dosing on outcomes in critically ill patients with acute kidney injury: a post hoc analysis of the EFFORT protein trial.
Trial report in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03160547 (The Effect of Higher Protein Dosing in Critically Ill Patients), which is not on this map. Cited by 34 papers, 2 of them syntheses that pooled it.
What it found
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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.
The Effect of Higher Protein Dosing in Critically Ill Patients: A Multicenter Registry-based Randomized Trial
Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 66 citations in OpenAlex.
- Influence of early enteral nutrition on mortality of adult patients with sepsis: a meta-analysis of randomized controlled trials.European journal of medical research · 2025Pooled it
- The effects of higher versus lower protein delivery in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.Critical care (London, England) · 2024Pooled it
- Combined intravenous bolus amino acid supplementation and mobilization on early muscle loss in critically ill adults: A randomized controlled trial.JPEN. Journal of parenteral and enteral nutrition · 2026Trial
- Association between protein dose in the early and late acute phases of critical illness and time-to-discharge-alive: A secondary analysis of a randomized clinical trial.JPEN. Journal of parenteral and enteral nutrition · 2026Trial
- Early phosphate changes as potential indicator of unreadiness for artificial feeding: a secondary analysis of the EPaNIC RCT.Critical care (London, England) · 2025Trial
- The effect of high protein dosing in critically ill patients: an exploratory, secondary Bayesian analyses of the EFFORT Protein trial.British journal of anaesthesia · 2024Trial
- Nutritional support in acute kidney injury requiring continuous renal replacement therapy: from metabolic alterations to clinical recommendations.International urology and nephrology · 2026Review
- Timing-specific neutrality in a rigorous ICU anabolic trial.JPEN. Journal of parenteral and enteral nutrition · 2026Article
- Interpreting protein dose trials in critical illness: a guide for the bedside clinician.Critical care (London, England) · 2026Review
- Protein nutrition in the ICU: a Delphi exercise to highlight knowledge and opinions of different professional groups involved in patient critical care.BMC nutrition · 2026Article
- Article
- Protein nutritional support in critically ill patients: pathophysiological basis, clinical evidence, and areas of uncertainty - a narrative review.Frontiers in medicine · 2026Review
- Achieving ≥70% of energy requirements during early enteral nutrition and short-term inflammatory-metabolic profiles in critically ill patients with sepsis: a prospective cohort study.Frontiers in nutrition · 2026Article
- Nutritional Risk and 30-Day In-Hospital Mortality in Adults With Sepsis and Septic Shock: A Retrospective Cohort Study.Journal of nursing management · 2026Article
- Functional and muscle recovery after critical illness: current and future nutritional, physical and metabolic strategies.Annals of intensive care · 2026Review
- Fueling recovery: evidence-based ICU nutrition and immunonutrition strategies in 2026.Trauma surgery & acute care open · 2026Review
- Low-protein diet for chronic kidney disease: Evidence, controversies, and practical guidelines.Journal of internal medicine · 2025Review
- The acute changes in intracellular amino acid production during sepsis do not relate to plasma concentrations.Clinical nutrition (Edinburgh, Scotland) · 2025Article
- The flux of energy in critical illness and the obesity paradox.Physiological reviews · 2025Review
- Nutritional Support for Necrotizing Soft Tissue Infection Patients: From ICU to Outpatient Care.Journal of clinical medicine · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors at 14 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBased on low-quality evidence, current nutrition guidelines recommend the delivery of high-dose protein in critically ill patients. The EFFORT Protein trial showed that higher protein dose is not associated with improved outcomes, whereas the effects in critically ill patients who developed acute kidney injury (AKI) need further evaluation. The overall aim is to evaluate the effects of high-dose protein in critically ill patients who developed different stages of AKI.
methodsIn this post hoc analysis of the EFFORT Protein trial, we investigated the effect of high versus usual protein dose (≥ 2.2 vs. ≤ 1.2 g/kg body weight/day) on time-to-discharge alive from the hospital (TTDA) and 60-day mortality and in different subgroups in critically ill patients with AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria within 7 days of ICU admission. The associations of protein dose with incidence and duration of kidney replacement therapy (KRT) were also investigated.
resultsOf the 1329 randomized patients, 312 developed AKI and were included in this analysis (163 in the high and 149 in the usual protein dose group). High protein was associated with a slower time-to-discharge alive from the hospital (TTDA) (hazard ratio 0.5, 95% CI 0.4-0.8) and higher 60-day mortality (relative risk 1.4 (95% CI 1.1-1.8). Effect modification was not statistically significant for any subgroup, and no subgroups suggested a beneficial effect of higher protein, although the harmful effect of higher protein target appeared to disappear in patients who received kidney replacement therapy (KRT). Protein dose was not significantly associated with the incidence of AKI and KRT or duration of KRT.
conclusionsIn critically ill patients with AKI, high protein may be associated with worse outcomes in all AKI stages. Recommendation of higher protein dosing in AKI patients should be carefully re-evaluated to avoid potential harmful effects especially in patients who were not treated with KRT.
trial registrationThis study is registered at ClinicalTrials.gov (NCT03160547) on May 17th 2017.
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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.