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Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group.

Publication ,  Journal Article
Zappitelli, M; Goldstein, SL; Symons, JM; Somers, MJG; Baum, MA; Brophy, PD; Blowey, D; Fortenberry, JD; Chua, AN; Flores, FX; Benfield, MR ...
Published in: Crit Care Med
December 2008

OBJECTIVE: Few published reports describe nutrition provision for critically ill children and young adults with acute kidney injury receiving continuous renal replacement therapy. The goals of this study were to describe feeding practices in pediatric continuous renal replacement therapy and to evaluate factors associated with over- and under-prescription of protein and calories. DESIGN: Retrospective database study. SETTING: Multicenter study in pediatric critical care units. PATIENTS: Patients with acute kidney injury (estimated glomerular filtration rate < 75 mL/min/1.73 m at continuous renal replacement therapy initiation) enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy Registry. INTERVENTIONS: None. MEASUREMENTS: Nutrition variables: initial and maximal protein (g/kg/day) and caloric (kcal/kg/day) prescription and predicted resting energy expenditure (kcal/kg/day). We determined factors predicting initial and maximal protein and caloric prescription by multivariate analysis. RESULTS: One hundred ninety-five patients (median [interquartile range] age = 8.1 [12.8] yrs, 56.9% men) were studied. Mean protein and caloric prescriptions at continuous renal replacement therapy initiation were 1.3 +/- 1.5 g/kg/day (median, 1.0; range, 0-10) and 37 +/- 27 kcal/kg/day (median, 32; range, 0-107). Mean maximal protein and caloric prescriptions during continuous renal replacement therapy were 2.0 +/- 1.5 g/kg/day (median, 1.7; range, 0-12) and 48 +/- 32 kcal/kg/day (median, 43; range, 0-117). Thirty-four percent of patients were initially prescribed < 1 g/kg/day protein; 23% never attained > 1 g/kg/day protein prescription. By continuous renal replacement therapy day 5, median protein prescribed was > 2 g/kg/day. Protein prescription practices differed substantially between medical centers with 5 of 10 centers achieving maximal protein prescription of > 2 g/kg/day in > or = 40% of patients. Caloric prescription exceeded predicted resting energy expenditure by 30%-100%. Factors independently associated with maximal protein and caloric prescription while on continuous renal replacement therapy were younger age, initial protein and caloric prescription and number of continuous renal replacement therapy treatment days (p < 0.05). CONCLUSIONS: Protein prescription in pediatric continuous renal replacement therapy may be inadequate. Inter-center variation exists with respect to nutrition prescription. Feeding practice standardization and research in pediatric acute kidney injury nutrition are essential to begin providing evidence-based feeding recommendations.

Duke Scholars

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

December 2008

Volume

36

Issue

12

Start / End Page

3239 / 3245

Location

United States

Related Subject Headings

  • Young Adult
  • Retrospective Studies
  • Renal Replacement Therapy
  • Registries
  • Nutritional Support
  • Male
  • Linear Models
  • Intensive Care Units, Pediatric
  • Infant, Newborn
  • Infant
 

Citation

APA
Chicago
ICMJE
MLA
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Zappitelli, M., Goldstein, S. L., Symons, J. M., Somers, M. J. G., Baum, M. A., Brophy, P. D., … Prospective Pediatric Continuous Renal Replacement Therapy Registry Group, . (2008). Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group. Crit Care Med, 36(12), 3239–3245. https://doi.org/10.1097/CCM.0b013e31818f3f40
Zappitelli, Michael, Stuart L. Goldstein, Jordan M. Symons, Michael J. G. Somers, Michelle A. Baum, Patrick D. Brophy, Douglas Blowey, et al. “Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group.Crit Care Med 36, no. 12 (December 2008): 3239–45. https://doi.org/10.1097/CCM.0b013e31818f3f40.
Zappitelli M, Goldstein SL, Symons JM, Somers MJG, Baum MA, Brophy PD, Blowey D, Fortenberry JD, Chua AN, Flores FX, Benfield MR, Alexander SR, Askenazi D, Hackbarth R, Bunchman TE, Prospective Pediatric Continuous Renal Replacement Therapy Registry Group. Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group. Crit Care Med. 2008 Dec;36(12):3239–3245.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

December 2008

Volume

36

Issue

12

Start / End Page

3239 / 3245

Location

United States

Related Subject Headings

  • Young Adult
  • Retrospective Studies
  • Renal Replacement Therapy
  • Registries
  • Nutritional Support
  • Male
  • Linear Models
  • Intensive Care Units, Pediatric
  • Infant, Newborn
  • Infant