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Enteral feeding may be more difficult in patients with AKI because of impaired gastrointestinal motility and decreased absorption of nutrients secondary to bowel edema.174 Moreover, multiple factors negatively affect gastrointestinal function in critically ill patients, e.g., medications (sedatives, opiates, catecholamines, etc.), glucose and electrolyte disorders, diabetes, or mechanical ventilation. However, the provision of nutrients via the gut lumen helps maintain gut integrity, decreases gut atrophy, and decreases bacterial and endotoxin translocation. Furthermore, AKI is a major risk factor for gastrointestinal hemorrhage.175 Enteral nutrition should exert protective effects on the risk of stress ulcers or bleeding. Clinical studies have suggested that enteral feeding is associated with improved outcome/survival in ICU patients.176,177 Hence, enteral nutrition is the recommended form of nutritional support for patients with AKI. If oral feeding is not possible, then enteral feeding (tube feeding) should be initiated within 24 hours, and has been shown to be safe and effective.178
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