Is parenteral nutrition with branched-chain amino acids (BCAAs) recommended in AKI?

• A. Yes
• B. Some studies suggest BCAA use improves nitrogen balance
• C. Only for patients on dialysis
• D. No, BCAA supplementation is not recommended in AKI

Answer: (D)

In AKI, there is no benefit to adding branched-chain amino acids specifically in parenteral nutrition, and doing so is not recommended because it can increase the nitrogen load without improving meaningful outcomes. The kidneys’ impaired ability to handle nitrogen means that extra BCAAs can raise nitrogenous waste (nitrogen balance improvements seen in some small studies do not translate into better renal recovery or survival). Therefore, standard PN focused on meeting total protein and energy needs is preferred, rather than selectively enriching with BCAAs. BCAA-enriched formulas are reserved for other conditions, such as certain liver diseases, where the amino acid balance has a targeted rationale. In AKI, follow guidelines for adequate protein (and energy) without special BCAA enrichment, and adjust based on the patient’s labs and clinical course.