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Adequacy of Nutritional Support in Critically Ill Children with Acute Kidney Injury

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Diet and Nutrition in Critical Care

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Abstract

Acute kidney injury (AKI) is a major contributory factor to overall morbidity and mortality in hospitalized patients. Management of AKI is largely supportive and should be aimed at eliminating the causative factors and preventing further damage, but the use of renal replacement therapy (RRT) is frequently required for severe AKI. AKI is caused by a sudden decline of glomerular filtration rate with an accumulation of metabolic waste products (urea), toxins, and drugs along with alterations in intrinsic function of the kidney, but it also influences nutrient substrate availability, utilization, and regulation. AKI is associated with hypercatabolism, excessive nitrogen loss, muscle wasting, hyperglycemia, hypertriglyceridemia, hypoalbuminemia, and electrolyte abnormalities. Such metabolic alterations induce protein–energy malnutrition and stunted growth in children. Underfeeding practices common in critically ill children are accentuated in AKI. Children with AKI should receive enough calories to provide 100–130 % of basal metabolic rate. Protein intake should not be restricted in AKI and should meet metabolic needs and compensate for frequent extra losses associated with RRT and proteinuria. Due to fluid overload, patients should be started on RRT in order to provide adequate nutrition. Efforts should be made to develop better nutritional assessment, to provide adequate nutrition in intensive care unit (ICU) patients with AKI, and to prospectively evaluate nutritional risk and outcomes during AKI.

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Abbreviations

ADQI:

Acute dialysis quality initiative

AKI:

Acute kidney injury

AKIN:

Acute kidney injury network

ASPEN:

American Society for Parenteral and Enteral Nutrition

BMR:

Basal metabolic rate

DRI:

Dietary reference intake

eCCl:

Estimated creatinine clearance

GFR:

Glomerular filtration rate

ICU:

Intensive care unit

ITT:

Intensive insulin therapy

KDIGO:

Kidney Disease: Improving Global Outcomes

REE:

Resting energy expenditure

RRT:

Renal replacement therapy

SCr:

Serum creatinine

TEE:

Total energy expenditure

WHO:

World Health Organization

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Authors and Affiliations

  1. Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin WT6-006, 77030, Houston, TX, USA

    Ursula G. Kyle, Ayse Akcan-Arikana & Renán A. Orellana

  2. Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin WT6-006, 77030, Houston, TX, USA

    Ayse Akcan-Arikana

  3. Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin W6006, 77030, Houston, TX, USA

    Renán A. Orellana & Jorge A. Coss-Bu

Authors
  1. Ursula G. Kyle
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  2. Ayse Akcan-Arikana
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  3. Renán A. Orellana
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  4. Jorge A. Coss-Bu
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Corresponding author

Correspondence to Ursula G. Kyle .

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Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Kyle, U.G., Akcan-Arikana, A., Orellana, R.A., Coss-Bu, J.A. (2014). Adequacy of Nutritional Support in Critically Ill Children with Acute Kidney Injury. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_135-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_135-1

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