Which of the following is NOT a documented disadvantage of high protein delivery in CRRT?

• A. Improved nitrogen balance
• B. Exacerbation of uremia
• C. Increased cost
• D. Increased hepatic and renal demand

Answer: (A)

The concept here is understanding why providing more protein during CRRT can be challenging. When you feed more protein to a patient on CRRT, you increase the amount of nitrogenous waste that the body has to process and that the dialysis circuit has to clear. That can raise the risk of things like rising urea levels if the clearance provided by CRRT isn’t increased accordingly, add to cost because more protein products and monitoring are needed, and place greater demand on hepatic and renal systems to metabolize amino acids and handle nitrogen balance. Keeping up with these factors is the reason higher protein delivery can be seen as a potential disadvantage.

Improving nitrogen balance, however, is not a disadvantage—it’s the expected benefit of adequately or aggressively providing protein during CRRT. Positive nitrogen balance means the patient is retaining more protein, which is the goal in many catabolic critically ill patients.