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. 2024 Feb 1;5(2):285-309.
doi: 10.34067/KID.0000000000000339. Epub 2023 Dec 19.

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations

Rupesh Raina  1   2 , Andrew Suchan  3 , Sidharth K Sethi  4 , Anvitha Soundararajan  1 , Victoria S Vitale  2 , Gerri L Keller  2 , Ann-Marie Brown  5   6   7 , Andrew Davenport  8 , Weiwen V Shih  9 , Arwa Nada  10 , Sharon Y Irving  11 , Sai Sudha Mannemuddhu  12   13 , Aylin S Crugnale  1 , Archana Myneni  1 , Katarina G Berry  11 , Jakub Zieg  14 , Khalid Alhasan  15 , Isabella Guzzo  16 , Natalie H Lussier  2 , Hui Kim Yap  17 , Timothy E Bunchman  18
Affiliations

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations

Rupesh Raina et al. Kidney360. .

Abstract

Background: Nutrition plays a vital role in the outcome of critically ill children, particularly those with AKI. Currently, there are no established guidelines for children with AKI treated with continuous RRT (CRRT). A thorough understanding of the metabolic changes and nutritional challenges in AKI and CRRT is required. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with AKI receiving CRRT.

Methods: PubMed, MEDLINE, Cochrane, and Embase databases were searched for articles related to the topic. Expertise of the authors and a consensus of the workgroup were additional sources of data in the article. Available articles on nutrition therapy in pediatric patients receiving CRRT through January 2023.

Results: On the basis of the literature review, the current evidence base was examined by a panel of experts in pediatric nephrology and nutrition. The panel used the literature review as well as their expertise to formulate clinical practice points. The modified Delphi method was used to identify and refine clinical practice points.

Conclusions: Forty-four clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with AKI and on CRRT on the basis of the existing literature and expert opinions of a multidisciplinary panel.

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Conflict of interest statement

T.E. Bunchman reports the following: Advisory or Leadership Role: editorial boards of Pediatric Critical Care and Pediatric Nephrology. A. Davenport reports the following: Consultancy: Fresenius Medical Care; Honoraria: Fresenius Medical Company and Nipro Corporation; and Advisory or Leadership Role: Advisory board—Yaqrit; Advisory board—Nipro Corporation; Advisory board—WAK Scientific advisory board; CJASN; Leadership positions; European Dialysis and Transplant Association ERN committee; and President–International Society for Hemodialysis. S.Y. Irving reports the following: Research Funding: Sigma Theta Tau International, Xi Chapter (at University of Pennsylvania School of Nursing); Advisory or Leadership Role: National Board Member, American Society for Parenteral and Enteral Nutrition; and Other Interests or Relationships: RWJF Health Policy Research Scholar Program, Institution Mentor. A. Nada reports the following: Other Interests or Relationships: Member of the American Society of Pediatric Nephrology and Member of the Neonatal Kidney Collaborative. H.K. Yap reports the following: Other Interests or Relationships: National Kidney Foundation, Singapore. All remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Metabolic changes in critical illness. A schematic diagram represents the metabolic changes in critical illness and their pathways. In critical illness, an increase in catabolic hormones, cytokines, and catecholamines and a decrease in anabolic hormones are observed. This leads to increased net muscle protein degradation and increased movement of free amino acids through the circulation. Amino acids contribute to gluconeogenesis and protein synthesis in the liver. An increase in carbohydrate turnover leads to increased glucose which is, in turn, used as fuel for the brain, RBCs, and kidneys. An increase in lipid turnover leads to an increase in FAs and ketones, which serve as fuel for the brain. Adapted from ref. . FA, fatty acid.
Figure 2
Figure 2
Evidence grading and strength of recommendations rubric. RCT, randomized control trial. Adapted from refs. and .
Figure 3
Figure 3
Changes in vitamins and trace elements. This diagram illustrates the changes in vitamins and trace elements during critical illness, their cellular metabolic role, contributing factors for their deficiency, and clinical presentation. Adapted from ref. . ICU, intensive care unit; PN, parenteral nutrition; GI, gastrointestinal; RER, rough endoplasmic reticulum.
See this image and copyright information in PMC

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