Feeding modality is a barrier to adequate protein provision in children receiving continuous renal replacement therapy (CRRT)

Background Critically ill children have a high prevalence of malnutrition. Children with acute kidney injury experience high rates of protein debt. Previous research has indicated that protein provision is positively associated with survival. Methods This was a prospective observational study of all...

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Published in:Pediatric nephrology (Berlin, West) West), 2019-06, Vol.34 (6), p.1147-1150
Main Authors: Wong Vega, Molly, Juarez Calderon, Marisa, Tufan Pekkucuksen, Naile, Srivaths, Poyyapakkam, Akcan Arikan, Ayse
Format: Article
Language:English
Subjects:
Analysis
Blood proteins
Brief Report
Child
Child, Preschool
Children
Continuous Renal Replacement Therapy - adverse effects
Enteral feeding
Feeding
Female
Humans
Inborn errors of metabolism
Male
Malnutrition
Malnutrition - etiology
Medicine
Medicine & Public Health
Nephrology
Nutrition
Nutritional Support - methods
Parenteral nutrition
Patients
Pediatric research
Pediatrics
Protein Deficiency - etiology
Proteins
Tube feeding
Urology
Weaning
What's New in Dialysis
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Summary:Background Critically ill children have a high prevalence of malnutrition. Children with acute kidney injury experience high rates of protein debt. Previous research has indicated that protein provision is positively associated with survival. Methods This was a prospective observational study of all patients receiving CRRT for greater than 48 h at our tertiary care institution. Patients with inborn errors of metabolism were excluded. Data collection included energy, protein, and fluid volume intakes, anthropometrics, feeding modality, and route of nutrition intake. Results Forty-one patients 9 ± 6.8 years of age, 66% male, received CRRT over a 10-month time period. CRRT treatment was 17.3 ± 25 days. Forty-one percent were malnourished via anthropometric criteria at CRRT start. Median protein delivery was 2 g/kg/day (IQR 1.4–2.5). Fifty-one percent received a combination of parenteral nutrition (PN) and enteral/oral feedings (EN), 34% received only PN, and 12% received only EN. Percentage of time meeting protein goals by modality was 27.6%, 34.6%, and 65.3% for those patients receiving solely EN, PN, and EN + PN combination, respectively. When weaned to only EN support from combination PN + EN, the average percentage of time protein goals were met decreased to 20.5% ( p  
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-019-04211-z