A survey on nutritional management of critically ill children on continuous renal replacement therapy

Rupesh Raina; Sidharth Kumar Sethi; Anvitha Soundararajan; Ann-Marie Brown; Kirsten Kusumi; Jonathan VanGeest; Timothy Bunchman

doi:10.1016/j.nut.2023.112024

A survey on nutritional management of critically ill children on continuous renal replacement therapy

Nutrition. 2023 Jul:111:112024. doi: 10.1016/j.nut.2023.112024. Epub 2023 Mar 9.

Authors

Rupesh Raina¹, Sidharth Kumar Sethi², Anvitha Soundararajan³, Ann-Marie Brown⁴, Kirsten Kusumi⁵, Jonathan VanGeest⁶, Timothy Bunchman⁷

Affiliations

¹ Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, Ohio, USA; Department of Pediatric Nephrology, Akron Children's Hospital, Akron, Ohio, USA. Electronic address: [email protected].
² Division of Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India.
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; Maynard Children's Hospital, ECU Health Medical Center, Greenville, North Carolina, USA.
⁵ Department of Pediatric Nephrology, Akron Children's Hospital, Akron, Ohio, USA.
⁶ College of Public Health, Kent State University, Kent, Ohio, USA.
⁷ Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA.

PMID: 37030052
DOI: 10.1016/j.nut.2023.112024

Abstract

We conducted a survey of pediatric nephrologists to examine the knowledge and current practices of and identify challenges in the nutritional management of critically ill children during continuous renal replacement therapy (CRRT). Although it is known that there is a significant effect on nutrition during CRRT, there seems to be a lack of knowledge as well as variability in the practices of nutritional management in these patients, as indicated by our survey results. The heterogeneity of our survey results highlights the need to establish clinical practice guidelines and develop consensus around optimal nutritional management in pediatric patients requiring CRRT. The results as well as the known effects of CRRT on metabolism should be considered during the development of guidelines in critically ill children on CRRT. Our survey findings also highlight the need for further research in the assessment of nutrition, determination of energy needs and caloric dosing, specific nutrient needs, and management.

Keywords: CRRT; Caloric need; Guidelines; Nutrition; Pediatrics.

MeSH terms

Child
Continuous Renal Replacement Therapy*
Critical Illness / therapy
Humans
Nutritional Status
Renal Replacement Therapy / adverse effects
Renal Replacement Therapy / methods