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Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group.
Crit Care Med. 2008 Dec; 36(12):3239-45.CC

Abstract

OBJECTIVE

Few published reports describe nutrition provision for critically ill children and young adults with acute kidney injury receiving continuous renal replacement therapy. The goals of this study were to describe feeding practices in pediatric continuous renal replacement therapy and to evaluate factors associated with over- and under-prescription of protein and calories.

DESIGN

Retrospective database study.

SETTING

Multicenter study in pediatric critical care units.

PATIENTS

Patients with acute kidney injury (estimated glomerular filtration rate < 75 mL/min/1.73 m at continuous renal replacement therapy initiation) enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy Registry.

INTERVENTIONS

None.

MEASUREMENTS

Nutrition variables: initial and maximal protein (g/kg/day) and caloric (kcal/kg/day) prescription and predicted resting energy expenditure (kcal/kg/day). We determined factors predicting initial and maximal protein and caloric prescription by multivariate analysis.

RESULTS

One hundred ninety-five patients (median [interquartile range] age = 8.1 [12.8] yrs, 56.9% men) were studied. Mean protein and caloric prescriptions at continuous renal replacement therapy initiation were 1.3 +/- 1.5 g/kg/day (median, 1.0; range, 0-10) and 37 +/- 27 kcal/kg/day (median, 32; range, 0-107). Mean maximal protein and caloric prescriptions during continuous renal replacement therapy were 2.0 +/- 1.5 g/kg/day (median, 1.7; range, 0-12) and 48 +/- 32 kcal/kg/day (median, 43; range, 0-117). Thirty-four percent of patients were initially prescribed < 1 g/kg/day protein; 23% never attained > 1 g/kg/day protein prescription. By continuous renal replacement therapy day 5, median protein prescribed was > 2 g/kg/day. Protein prescription practices differed substantially between medical centers with 5 of 10 centers achieving maximal protein prescription of > 2 g/kg/day in > or = 40% of patients. Caloric prescription exceeded predicted resting energy expenditure by 30%-100%. Factors independently associated with maximal protein and caloric prescription while on continuous renal replacement therapy were younger age, initial protein and caloric prescription and number of continuous renal replacement therapy treatment days (p < 0.05).

CONCLUSIONS

Protein prescription in pediatric continuous renal replacement therapy may be inadequate. Inter-center variation exists with respect to nutrition prescription. Feeding practice standardization and research in pediatric acute kidney injury nutrition are essential to begin providing evidence-based feeding recommendations.

Authors+Show Affiliations

Baylor College of Medicine, Houston, TX, USA. mzaprdr@yahoo.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18936697

Citation

Zappitelli, Michael, et al. "Protein and Calorie Prescription for Children and Young Adults Receiving Continuous Renal Replacement Therapy: a Report From the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group." Critical Care Medicine, vol. 36, no. 12, 2008, pp. 3239-45.
Zappitelli M, Goldstein SL, Symons JM, et al. Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group. Crit Care Med. 2008;36(12):3239-45.
Zappitelli, M., Goldstein, S. L., Symons, J. M., Somers, M. J., Baum, M. A., Brophy, P. D., Blowey, D., Fortenberry, J. D., Chua, A. N., Flores, F. X., Benfield, M. R., Alexander, S. R., Askenazi, D., Hackbarth, R., & Bunchman, T. E. (2008). Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group. Critical Care Medicine, 36(12), 3239-45. https://doi.org/10.1097/CCM.0b013e31818f3f40
Zappitelli M, et al. Protein and Calorie Prescription for Children and Young Adults Receiving Continuous Renal Replacement Therapy: a Report From the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group. Crit Care Med. 2008;36(12):3239-45. PubMed PMID: 18936697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group. AU - Zappitelli,Michael, AU - Goldstein,Stuart L, AU - Symons,Jordan M, AU - Somers,Michael J G, AU - Baum,Michelle A, AU - Brophy,Patrick D, AU - Blowey,Douglas, AU - Fortenberry,James D, AU - Chua,Annabelle N, AU - Flores,Francisco X, AU - Benfield,Mark R, AU - Alexander,Steven R, AU - Askenazi,David, AU - Hackbarth,Richard, AU - Bunchman,Timothy E, AU - ,, PY - 2008/10/22/pubmed PY - 2008/12/18/medline PY - 2008/10/22/entrez SP - 3239 EP - 45 JF - Critical care medicine JO - Crit Care Med VL - 36 IS - 12 N2 - OBJECTIVE: Few published reports describe nutrition provision for critically ill children and young adults with acute kidney injury receiving continuous renal replacement therapy. The goals of this study were to describe feeding practices in pediatric continuous renal replacement therapy and to evaluate factors associated with over- and under-prescription of protein and calories. DESIGN: Retrospective database study. SETTING: Multicenter study in pediatric critical care units. PATIENTS: Patients with acute kidney injury (estimated glomerular filtration rate < 75 mL/min/1.73 m at continuous renal replacement therapy initiation) enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy Registry. INTERVENTIONS: None. MEASUREMENTS: Nutrition variables: initial and maximal protein (g/kg/day) and caloric (kcal/kg/day) prescription and predicted resting energy expenditure (kcal/kg/day). We determined factors predicting initial and maximal protein and caloric prescription by multivariate analysis. RESULTS: One hundred ninety-five patients (median [interquartile range] age = 8.1 [12.8] yrs, 56.9% men) were studied. Mean protein and caloric prescriptions at continuous renal replacement therapy initiation were 1.3 +/- 1.5 g/kg/day (median, 1.0; range, 0-10) and 37 +/- 27 kcal/kg/day (median, 32; range, 0-107). Mean maximal protein and caloric prescriptions during continuous renal replacement therapy were 2.0 +/- 1.5 g/kg/day (median, 1.7; range, 0-12) and 48 +/- 32 kcal/kg/day (median, 43; range, 0-117). Thirty-four percent of patients were initially prescribed < 1 g/kg/day protein; 23% never attained > 1 g/kg/day protein prescription. By continuous renal replacement therapy day 5, median protein prescribed was > 2 g/kg/day. Protein prescription practices differed substantially between medical centers with 5 of 10 centers achieving maximal protein prescription of > 2 g/kg/day in > or = 40% of patients. Caloric prescription exceeded predicted resting energy expenditure by 30%-100%. Factors independently associated with maximal protein and caloric prescription while on continuous renal replacement therapy were younger age, initial protein and caloric prescription and number of continuous renal replacement therapy treatment days (p < 0.05). CONCLUSIONS: Protein prescription in pediatric continuous renal replacement therapy may be inadequate. Inter-center variation exists with respect to nutrition prescription. Feeding practice standardization and research in pediatric acute kidney injury nutrition are essential to begin providing evidence-based feeding recommendations. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/18936697/Protein_and_calorie_prescription_for_children_and_young_adults_receiving_continuous_renal_replacement_therapy:_a_report_from_the_Prospective_Pediatric_Continuous_Renal_Replacement_Therapy_Registry_Group_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31818f3f40 DB - PRIME DP - Unbound Medicine ER -