{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T02:19:06Z","timestamp":1768443546234,"version":"3.49.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p>It is rare for patients to survive and be discharged with extensive severe burns in combination with severe acute kidney injury (AKI). The case under discussion involved a patient who had sustained critical burn injuries, with 96% of the patient\u2019s total body surface area affected, 80% of which were categorized as third-degree burns. Severe AKI was observed on the initial day following the burn injury, and continuous renal replacement therapy (CRRT) was commenced on the subsequent day. In response to inadequate oral intake, long-term enteral and supplemental parenteral nutrition was administered. To address the hypermetabolic state and promote wound healing, a dynamic, individualized nutritional support plan was implemented during the patient\u2019s hospitalization. Regular monitoring of patients\u2019 resting energy expenditure via indirect calorimetry ensures adequate energy and nutrient substrates are provided, while administering growth hormone to promote wound healing. Nutritional therapy efficacy is dynamically assessed through wound healing rate, clinical signs, serum prealbumin levels, and other relevant indicators to guide timely adjustments in nutritional intervention. On the 96th day, the patient\u2019s wound had mostly healed and was transferred to a rehabilitation facility for continued treatment. This case presents an exceptionally complex clinical scenario, combining extensive burns with acute kidney injury. During a period of 95 consecutive days of CRRT, the burn wounds achieved substantial healing and the patient survived to discharge. A comparison with previously published case reports indicates that the case we report is distinguished by a larger total burn surface area, a prolonged course of CRRT, and a markedly more convoluted clinical trajectory. A precise, continuously refined nutritional support strategy and multidisciplinary team collaboration were instrumental in achieving a favorable outcome.<\/jats:p>","DOI":"10.3389\/fnut.2025.1749501","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T15:35:11Z","timestamp":1768404911000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing nutrition and metabolism in a severely burned patient during prolonged continuous renal replacement therapy: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Haili","family":"Shan","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Burns and Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yulu","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Haiyan People's Hospital","place":["Jiaxing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Department of Traditional Chinese Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuangang","family":"You","sequence":"additional","affiliation":[{"name":"Department of Burns and Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunmao","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Burns and Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"ref1","first-page":"1228","article-title":"Rethinking burns for low & middle-income countries: differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries","volume-title":"Burns","author":"Dav\u00e9","year":"2018"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/s41572-020-0145-5","article-title":"Burn injury","volume":"6","author":"Jeschke","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1513\/AnnalsATS.202110-1099CME","article-title":"Care of the Critically Injured Burn Patient","volume":"19","author":"Bagley","year":"2022","journal-title":"Ann Am Thorac Soc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/SLA.0b013e3181856241","article-title":"Pathophysiologic response to severe burn injury","volume":"248","author":"Jeschke","year":"2008","journal-title":"Ann Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"805","DOI":"10.3760\/cma.j.cn501120-20210802-00264","article-title":"Metabolic staging and nutritional treatment strategies of severely burned patients","volume":"37","author":"Peng","year":"2021","journal-title":"Chin J Burns"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1016\/S0140-6736(04)16360-5","article-title":"Support of the metabolic response to burn injury","volume":"363","author":"Herndon","year":"2004","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/j.clnu.2013.02.012","article-title":"ESPEN endorsed recommendations: nutritional therapy in major burns","volume":"32","author":"Rousseau","year":"2013","journal-title":"Clin Nutr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1002\/jpen.1452","article-title":"AGREEing on guidelines for nutrition Management of Adult Severe Burn Patients","volume":"43","author":"Grammatikopoulou","year":"2019","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/SLA.0000000000001979","article-title":"Acute kidney injury in burn patients: clinically significant over the initial hospitalization and 1 year after injury: an original retrospective cohort study","volume":"266","author":"Thalji","year":"2017","journal-title":"Ann Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1762","DOI":"10.1016\/j.burns.2024.05.019","article-title":"Long-term renal function after burn-related acute kidney injury with continuous renal replacement therapy","volume":"50","author":"Gordon","year":"2024","journal-title":"Burns"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1038\/s41581-023-00769-y","article-title":"Acute kidney injury in patients with burns","volume":"20","author":"Legrand","year":"2024","journal-title":"Nat Rev Nephrol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.jointm.2022.11.001","article-title":"Metabolic and nutritional aspects in continuous renal replacement therapy","volume":"3","author":"Fishman","year":"2023","journal-title":"J Intensive Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1097\/CCM.0000000000001525","article-title":"Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (a.S.P.E.N.)","volume":"44","author":"Taylor","year":"2016","journal-title":"Crit Care Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1093\/jbcr\/irac025","article-title":"Burn shock and resuscitation: review and state of the science","volume":"43","author":"Cartotto","year":"2022","journal-title":"J Burn Care Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1093\/jbcr\/irad125","article-title":"American burn association clinical practice guidelines on burn shock resuscitation","volume":"45","author":"Cartotto","year":"2024","journal-title":"J Burn Care Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/j.pmr.2023.06.001","article-title":"Burn patient metabolism and nutrition","volume":"34","author":"Nunez","year":"2023","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jcrc.2012.06.003","article-title":"Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration--a comparison between 2 citrate modalities and unfractionated heparin","volume":"28","author":"Balik","year":"2013","journal-title":"J Crit Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"257","DOI":"10.3389\/fped.2018.00257","article-title":"Indirect calorimetry: history, technology, and application","volume":"6","author":"Mtaweh","year":"2018","journal-title":"Front Pediatr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.clnu.2020.06.024","article-title":"Indirect calorimetry: the 6 main issues","volume":"40","author":"Achamrah","year":"2021","journal-title":"Clin Nutr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1007\/s00134-009-1420-9","article-title":"Continuous renal replacement therapy amino acid, trace metal and folate clearance in critically ill children","volume":"35","author":"Zappitelli","year":"2009","journal-title":"Intensive Care Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1016\/s0899-9007(03)00107-2","article-title":"Impact of increasing parenteral protein loads on amino acid levels and balance in critically ill anuric patients on continuous renal replacement therapy","volume":"19","author":"Scheinkestel","year":"2003","journal-title":"Nutrition"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"309","DOI":"10.5603\/AIT.a2017.0052","article-title":"Practical issues of nutrition during continuous renal replacement therapy","volume":"49","author":"Onichimowski","year":"2017","journal-title":"Anaesthesiol Intensive Ther"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.clnu.2019.02.034","article-title":"Energy expenditure and caloric targets during continuous renal replacement therapy under regional citrate anticoagulation. A viewpoint","volume":"39","author":"Jonckheer","year":"2020","journal-title":"Clin Nutr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.clnu.2025.01.004","article-title":"Nutrition therapy for critically ill patients - five key problems","volume":"46","author":"Kreymann","year":"2025","journal-title":"Clinical Nutr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/14651858.CD008990.pub3","article-title":"Recombinant human growth hormone for treating burns and donor sites","volume":"9","author":"Breederveld","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"568","DOI":"10.3760\/cma.j.issn.1009-2587.2017.09.009","article-title":"Systematic evaluation on effectiveness and safety of recombinant human growth hormone in treating adult patients with severe burn","volume":"33","author":"Tian","year":"2017","journal-title":"Zhonghua Shao Shang Za Zhi"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"236","DOI":"10.3760\/cma.j.issn.1009-2587.2010.03.026","article-title":"Consensus on the use of recombinant human growth hormone in the treatment of burns","volume":"26","year":"2010","journal-title":"Chinese Journal of Burns"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1002\/ncp.10362","article-title":"Glutamine in burn injury","volume":"34","author":"Wischmeyer","year":"2019","journal-title":"Nutr Clin Pract"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1016\/j.clnu.2023.07.011","article-title":"ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit","volume":"42","author":"Singer","year":"2023","journal-title":"Clin Nutr"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1177\/0884533613486297","article-title":"Commonly used \"nutrition\" indicators do not predict outcome in the critically ill: a systematic review","volume":"28","author":"Ferrie","year":"2013","journal-title":"Nutr Clin Pract"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1016\/j.clnu.2024.04.015","article-title":"Dynamic assessment of prealbumin for nutrition support effectiveness in critically ill patients","volume":"43","author":"Pardo","year":"2024","journal-title":"Clinical Nutr"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1177\/0148607110374577","article-title":"A.S.P.E.N. Clinical guidelines: nutrition support in adult acute and chronic renal failure","volume":"34","author":"Brown","year":"2010","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1016\/j.clnu.2021.01.028","article-title":"ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease","volume":"40","author":"Fiaccadori","year":"2021","journal-title":"Clin Nutr"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1007\/s13668-018-0232-3","article-title":"Use of enteral nutrition for gastrointestinal bleeding prophylaxis in the critically ill: review of current literature","volume":"7","author":"Newberry","year":"2018","journal-title":"Curr Nutr Rep"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1056\/nejm199402103300601","article-title":"Risk factors for gastrointestinal bleeding in critically ill patients","volume":"330","author":"Cook","year":"1994","journal-title":"N Engl J Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1097\/MCC.0000000000000803","article-title":"Prevention of gastrointestinal bleeding in critically ill patients","volume":"27","author":"Al-Dorzi","year":"2021","journal-title":"Curr Opin Crit Care"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1948","DOI":"10.1007\/s00134-020-06136-w","article-title":"Stress ulcer prophylaxis plus enteral nutrition versus enteral nutrition alone in critically ill patients at risk for gastrointestinal bleeding: a propensity-matched analysis","volume":"46","author":"Ohbe","year":"2020","journal-title":"Intensive Care Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/mcc.0000000000001251","article-title":"Pharmacological prevention of gastrointestinal bleeding in critically ill patients","volume":"31","author":"Wong","year":"2025","journal-title":"Curr Opin Crit Care"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1001\/archsurg.1980.01380090047011","article-title":"Prevention of upper gastrointestinal bleeding in burn patients: a role for 'elemental' diet","volume":"115","author":"Choctaw","year":"1980","journal-title":"Arch Surg"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/00003246-198301000-00005","article-title":"Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients","volume":"11","author":"Pingleton","year":"1983","journal-title":"Crit Care Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/s0305-4179(97)89875-0","article-title":"The value of early enteral nutrition in the prophylaxis of stress ulceration in the severely burned patient","volume":"23","author":"Raff","year":"1997","journal-title":"Burns"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.clnu.2018.08.037","article-title":"ESPEN guideline on clinical nutrition in the intensive care unit","volume":"38","author":"Singer","year":"2019","journal-title":"Clin Nutr"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/s0305-4179(02)00006-2","article-title":"Enteral feeding in patients with major burn injury: the use of nasojejunal feeding after the failure of nasogastric feeding","volume":"28","author":"Sefton","year":"2002","journal-title":"Burns"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.clnu.2014.10.009","article-title":"Enteral access in adults","volume":"34","author":"Toussaint","year":"2015","journal-title":"Clin Nutr"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s41038-017-0076-x","article-title":"Nutrition and metabolism in burn patients","volume":"5","author":"Clark","year":"2017","journal-title":"Burns Trauma"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"13","DOI":"10.20960\/nh.05302","article-title":"Multidisciplinary approach to nutritional medical therapy in critical patients","volume":"41","author":"Lalueza Broto","year":"2024","journal-title":"Nutr Hosp"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.clnu.2023.12.007","article-title":"Implementation of a multidisciplinary nutritional support team and clinical outcomes in critically ill patients with COVID-19","volume":"43","author":"Song","year":"2024","journal-title":"Clin Nutr"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1769","DOI":"10.1186\/s40064016-3431-7","article-title":"Combined application of nasogastric tubes and nasointestinal tubes in neurosurgical intensive care patients with stress ulceration: a novel solution to treatment and early enteral nutrition","volume":"5","author":"Lu","year":"2016","journal-title":"Springerplus"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1749501\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T15:35:15Z","timestamp":1768404915000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1749501\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,14]]},"references-count":48,"alternative-id":["10.3389\/fnut.2025.1749501"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2025.1749501","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,14]]},"article-number":"1749501"}}