• Nutrition · Mar 2024

    Review

    Nutrition in critically ill children with acute kidney injury on continuous kidney replacement therapy: An integrative review and clinical practice points 2023.

    • 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, and Sidharth K Sethi.
    • Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, Ohio, USA; Akron Children's Hospital, Akron, Ohio, USA. Electronic address: rraina@akronchildrens.org.
    • Nutrition. 2024 Mar 1; 119: 112272112272.

    ObjectivesNutrition 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.MethodsAn 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.ResultsThe 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.ConclusionsClinical 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.Copyright © 2023 Elsevier Inc. All rights reserved.

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