Most critically ill patients with acute kidney injury (AKI) have an increased metabolism. This is likely due to the underlying event leading to critical illness that rather than AKI per se. Furthermore, if the patient is on dialysis they will have additional calorie demands due to loss of glucose, amino acids, and heat. Thus, the need to maintain adequate metabolic demand from enteral or pareneral supplementation could impact outcomes. As such, increasing both the calorie and protein delivery to the patient with critical illness and AKI can compensate for the increased metabolism seen in AKI.