{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:30:16Z","timestamp":1791304216908,"version":"4.3.1"},"reference-count":41,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Critically ill patients receiving continuous renal replacement therapy (CRRT) face distinct nutritional challenges requiring specialized parenteral nutrition (PN) strategies. This review synthesizes current evidence with clinical expertise to provide a comprehensive nutritional framework for this population. Key findings reveal that CRRT significantly impacts nutrient homeostasis through daily losses of amino acids (14\u201322 g), water-soluble vitamins, and trace elements via the extracorporeal circuit. Results from observational studies demonstrate that higher protein targets (1.8\u20132.5 g\/kg\/day) are necessary to achieve positive nitrogen balance, while energy prescriptions must subtract \u201chidden\u201d calories from citrate anticoagulation (3\u20134 kcal\/mmol) and propofol (1.1 kcal\/mL). Clinical outcome data, though primarily observational, indicate that achieving nutritional adequacy correlates with reduced ICU stays (average reduction 2.1\u20133.4 days), shorter mechanical ventilation duration, and improved functional recovery. Evidence supports that early PN prescription when indicated, coupled with systematic consideration of therapy modality, extracorporeal losses, oral intake capacity, and mobilization status, optimizes nutritional support. We conclude that successful implementation requires: (1) dynamic adjustment based on CRRT parameters, (2) integration with enteral nutrition when feasible, (3) regular metabolic monitoring, (4) multidisciplinary collaboration, and (5) structured protocols. Future research using point-of-care analysis and AI-driven support systems is needed to establish evidence-based guidelines in this specialized population.<\/jats:p>","DOI":"10.3390\/jpm15110545","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T13:51:08Z","timestamp":1762782668000},"page":"545","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Personalized Parenteral Nutrition in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy: A Comprehensive Framework for Clinical Practice"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0430-4682","authenticated-orcid":false,"given":"Nicola","family":"Sinatra","sequence":"first","affiliation":[{"name":"Nephrology and Dialysis Unit, \u201cPaolo Borsellino\u201d Hospital, 91025 Marsala, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1251-0185","authenticated-orcid":false,"given":"Antonino","family":"Maniaci","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5271-1810","authenticated-orcid":false,"given":"Giuseppe","family":"Cuttone","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, \u2018Abele Ajello\u2019 Hospital, ASP Trapani, 91026 Mazara del Vallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6159-8886","authenticated-orcid":false,"given":"Tarek","family":"Senussi Testa","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia and Intensive Care, Cardiovascular Network, IRCCS Policlinico San Martino Hospital, 16121 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Tutino","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Hospital \u201cGiovanni Paolo II\u201d ASP Ragusa, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0215-5620","authenticated-orcid":false,"given":"Daniele","family":"Patern\u00f2","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Hospital \u201cGiovanni Paolo II\u201d ASP Ragusa, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8385-9560","authenticated-orcid":false,"given":"Alessandro","family":"Girombelli","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, SS Annunziata Hospital, ASLCN 1, 12038 Savigliano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Ippati","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cS.A. Abate\u201d Hospital, 91016 Erice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9746-0534","authenticated-orcid":false,"given":"Giorgia","family":"Caputo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9331-2788","authenticated-orcid":false,"given":"Massimiliano","family":"Sorbello","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, \u201cKore\u201d University, 94100 Enna, Italy"},{"name":"Department of Anesthesia and Intensive Care, Hospital \u201cGiovanni Paolo II\u201d ASP Ragusa, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-7554","authenticated-orcid":false,"given":"Luigi","family":"La Via","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1177\/08850666241246748","article-title":"Parenteral Nutrition in the Critically Ill Adult: A Narrative Review","volume":"40","author":"Nguyen","year":"2025","journal-title":"J. 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