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Continuous renal replacement therapy amino acid, trace metal and folate clearance in critically ill children

Intensive Care Medicine volume 35, pages 698–706 (2009)Cite this article

Abstract

Purpose

We hypothesized continuous veno-venous hemodialysis (CVVHD) amino acid, trace metals and folate clearance impacts nutrient balance.

Methods

Critically ill children receiving CVVHD were studied prospectively for 5 days. Blood concentrations (amino acids, copper, zinc, manganese, chromium, selenium and folate) were measured at CVVHD initiation, and Days 2 and 5. CVVHD clearance, losses and nutrient balances were calculated on Days 2 and 5.

Results

We studied 15 children aged 7.7 ± 6.7 years. Nitrogen balance was negative on Days 2 and 5. Amino acid clearances ranged from 2.8 to 51.1 ml/min per 1.73 m2. CVVHD losses corresponded to 20% of intake. Days 2 and 5 balances were negative for selenium, but positive for other trace metals. Folate clearance was 16 ml/min per 1.73 m2 on Days 2 and 5 and serum concentrations decreased significantly from initiation to Day 5 (P < 0.05).

Conclusions

Nutrient losses by CVHHD may impact adequate nutrition provision.

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Fig. 1

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Acknowledgments

We acknowledge Amrita Naipaul for her assistance in data collection and Walter O’Rourke (Dialysis Solutions Inc.) and Lee Ware (Baxter Healthcare) for their financial support. Dr. Zappitelli received a post-doctoral research fellowship award from the Kidney Research Scientist Core and National Training Program to fund his training at the Baylor College of Medicine/Texas Children’s Hospital Acute Care Nephrology Research Fellowship.

Conflict of interest statement

This investigator-initiated project was funded by unrestricted grants from Dialysis Solutions Inc. and Baxter Healthcare.

Author information

Affiliations

  1. Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Michael Zappitelli & Stuart L. Goldstein

  2. Texas Children’s Hospital, 6621 Fannin Street, MC 3-2482, Houston, TX, 77054, USA

    Marisa Juarez & Stuart L. Goldstein

  3. Critical Care Medicine Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    L. Castillo & Jorge Coss-Bu

Authors
  1. Michael Zappitelli
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  2. Marisa Juarez
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  3. L. Castillo
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  4. Jorge Coss-Bu
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  5. Stuart L. Goldstein
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Corresponding author

Correspondence to Stuart L. Goldstein.

Appendix

Appendix

See Table 5.

Table 5 Serum amino acid concentrations [mean, median (IQR) μmol/l] at CVVHD initiation, CVVHD Days 2 and 5
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Zappitelli, M., Juarez, M., Castillo, L. et al. Continuous renal replacement therapy amino acid, trace metal and folate clearance in critically ill children. Intensive Care Med 35, 698–706 (2009). https://doi.org/10.1007/s00134-009-1420-9

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  • DOI: https://doi.org/10.1007/s00134-009-1420-9

Keywords

  • Continuous veno-venous hemodialysis
  • Pediatric
  • Intensive care
  • Nutrition
  • Protein
  • Vitamins