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Feeding modality is a barrier to adequate protein provision in children receiving continuous renal replacement therapy (CRRT)

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Abstract

Background

Critically ill children have a high prevalence of malnutrition. Children with acute kidney injury experience high rates of protein debt. Previous research has indicated that protein provision is positively associated with survival.

Methods

This was a prospective observational study of all patients receiving CRRT for greater than 48 h at our tertiary care institution. Patients with inborn errors of metabolism were excluded. Data collection included energy, protein, and fluid volume intakes, anthropometrics, feeding modality, and route of nutrition intake.

Results

Forty-one patients 9 ± 6.8 years of age, 66% male, received CRRT over a 10-month time period. CRRT treatment was 17.3 ± 25 days. Forty-one percent were malnourished via anthropometric criteria at CRRT start. Median protein delivery was 2 g/kg/day (IQR 1.4–2.5). Fifty-one percent received a combination of parenteral nutrition (PN) and enteral/oral feedings (EN), 34% received only PN, and 12% received only EN. Percentage of time meeting protein goals by modality was 27.6%, 34.6%, and 65.3% for those patients receiving solely EN, PN, and EN + PN combination, respectively. When weaned to only EN support from combination PN + EN, the average percentage of time protein goals were met decreased to 20.5% (p < 0.01).

Conclusions

Without PN, patients on enteral/oral nutrition support fail to meet appropriate protein prescription. Transition of parenteral to enteral feeds was identified as a period of nutritional risk in children receiving CRRT.

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Acknowledgments

We would like to acknowledge the time-intensive efforts of our nephrology and critical care teams at Texas Children’s Hospital and Baylor College of Medicine in working with our renal extracorporeal quality improvement team to improve the safety, quality of care, and nutrition provided to our patients.

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Authors and Affiliations

  1. Sections of Nephrology, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, Suite 245, Houston, TX, 77033, USA

    Molly Wong Vega, Marisa Juarez Calderon, Naile Tufan Pekkucuksen, Poyyapakkam Srivaths & Ayse Akcan Arikan

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

    Ayse Akcan Arikan

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  1. Molly Wong Vega
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  2. Marisa Juarez Calderon
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  3. Naile Tufan Pekkucuksen
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Contributions

The results presented in this paper have not been published previously in whole or part, except in abstract form. Dr. Ayse Akcan Arikan and Molly Wong Vega developed the study design, analyzed, and interpreted data. All authors (Marisa Juarez, MPH, RD; Naile Tufan Pekkucuksen, MD; Poyyapakkam Srivaths, MD; Ayse Akcan Arikan, MD and Molly Wong Vega, MS, RD) assisted in writing, editing, and approving the manuscript.

Corresponding author

Correspondence to Molly Wong Vega.

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Ethical approval

This study was approved throught Baylor College of Medicine institutional review board. Consent was waived as information was obtained via usual patient care monitoring.

Conflicts of interest

Mrs. Juarez Calderon disclosed that her husband works for Baxter. Dr. Ackan Arikan’s institution received funding from Baxter. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Wong Vega, M., Juarez Calderon, M., Tufan Pekkucuksen, N. et al. Feeding modality is a barrier to adequate protein provision in children receiving continuous renal replacement therapy (CRRT). Pediatr Nephrol 34, 1147–1150 (2019). https://doi.org/10.1007/s00467-019-04211-z

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  • DOI: https://doi.org/10.1007/s00467-019-04211-z

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