Nutrition in critically ill children with acute kidney injury on continuous kidney replacement therapy: a 2023 executive summary

Rupesh Raina; Andrew Suchan; Anvitha Soundararajan; Ann-Marie Brown; Andrew Davenport; Weiwen V Shih; Arwa Nada; Sharon Y Irving; Sai Sudha Mannemuddhu; Victoria S Vitale; Aylin S Crugnale; Gerri L Keller; Katarina G Berry; Jakub Zieg; Khalid Alhasan; Isabella Guzzo; Natalie H Lussier; Hui Kim Yap; Timothy E Bunchman; Sidharth K Sethi

doi:10.1016/j.nut.2023.112272

Nutrition in critically ill children with acute kidney injury on continuous kidney replacement therapy: a 2023 executive summary

Nutrition. 2024 Mar:119:112272. doi: 10.1016/j.nut.2023.112272. Epub 2023 Nov 2.

Authors

Rupesh Raina¹, Andrew Suchan², Anvitha Soundararajan³, Ann-Marie Brown⁴, Andrew Davenport⁵, Weiwen V Shih⁶, Arwa Nada⁷, Sharon Y Irving⁸, Sai Sudha Mannemuddhu⁹, Victoria S Vitale¹⁰, Aylin S Crugnale³, Gerri L Keller¹⁰, Katarina G Berry⁸, Jakub Zieg¹¹, Khalid Alhasan¹², Isabella Guzzo¹³, Natalie H Lussier¹⁰, Hui Kim Yap¹⁴, Timothy E Bunchman¹⁵, Sidharth K Sethi¹⁶

Affiliations

¹ Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, Ohio, USA; Akron Children's Hospital, Akron, Ohio, USA. Electronic address: [email protected].
² Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
³ Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, Ohio, USA.
⁴ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Children's Healthcare of Atlanta, Atlanta, Georgia, USA; ECU Health, Greenville, North Carolina, USA.
⁵ UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK.
⁶ Children's Hospital Colorado, University of Colorado, Section of Pediatric Nephrology, Aurora, Colorado, USA.
⁷ Division of Pediatric Nephrology, Department of Pediatrics, Le Bonheur Children's Hospital and St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁸ University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁹ Division of Pediatric Nephrology, East Tennessee Children's Hospital, Knoxville, Tennessee, USA; Department of Medicine, University of Tennessee, Knoxville, Tennessee, USA.
¹⁰ Akron Children's Hospital, Akron, Ohio, USA.
¹¹ Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
¹² Pediatrics Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
¹³ Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
¹⁴ Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹⁵ Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA.
¹⁶ Department of Pediatric Nephrology, Kidney Institute, Medanta-The Medicity, Gurgaon, India.

PMID: 38118382
DOI: 10.1016/j.nut.2023.112272

Abstract

Objectives: Nutrition plays a vital role in the outcome of critical illness in children, particularly those with acute kidney injury. Currently, there are no established guidelines for children with acute kidney injury treated with continuous kidney replacement therapy. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with acute kidney injury receiving continuous kidney replacement therapy.

Methods: An electronic search using PubMed and an inclusive academic library search (including MEDLINE, Cochrane, and Embase databases) was conducted to find relevant English-language articles on nutrition therapy for children (<18 y of age) receiving continuous kidney replacement therapy.

Results: The existing literature was reviewed by our work group, comprising pediatric nephrologists and experts in nutrition. The modified Delphi method was then used to develop a total of 45 clinical practice points. The best methods for nutritional assessment are discussed. Indirect calorimetry is the most reliable method of predicting resting energy expenditure in children on continuous kidney replacement therapy. Schofield equations can be used when indirect calorimetry is not available. The non-intentional calories contributed by continuous kidney replacement therapy should also be accounted for during caloric dosing. Protein supplementation should be increased to account for the proteins, peptides, and amino acids lost with continuous kidney replacement therapy.

Conclusions: Clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with acute kidney injury and on continuous kidney replacement therapy based on the existing literature and expert opinions of a multidisciplinary panel.

Keywords: Acute kidney failure; Continuous kidney replacement therapy; Indirect calorimetry; Pediatrics; nutrition.

Publication types

Review

MeSH terms

Acute Kidney Injury* / therapy
Adolescent
Calorimetry, Indirect / methods
Child
Child, Preschool
Continuous Renal Replacement Therapy* / methods
Critical Illness* / therapy
Delphi Technique
Humans
Nutrition Assessment*
Nutritional Status
Renal Replacement Therapy / methods