Renal replacement therapy lacks in protein delivery in pediatric congenital heart disease
Click Here to Manage Email Alerts
Renal replacement therapy was insufficient for protein delivery in critically ill children with congenital heart disease, according to a single-center retrospective cohort study in Journal of Renal Nutrition.
“Although several studies have been conducted in critically ill children with AKI, there are limited data evaluating the nutritional status and nutrient intake in patients with congenital heart disease (CHD) receiving [renal replacement therapy] RRT,” Daniel L. Hames, MD, of Boston Children’s Hospital’s division of cardiovascular critical care and Harvard Medical School’s department of pediatrics, and colleagues wrote. “Furthermore, identification of the barriers to the delivery of adequate nutrition in this population could provide clinically relevant information in the assessment and management of these patients.”
Hames and associates examined data from 60 patients with CHD (median age, 5.2 years; 67% male patients) treated with RRT at a pediatric cardiac ICU between Jan. 1, 2011, and Dec. 31, 2019. Aside from 12 patients older than 18 years of age, all participants were children. Researchers determined fluid balance and energy and protein targets and adequacy in the first 7 days of RRT, with adequacy defined as more than 80% delivery of protein and energy.
The only significant comorbidity unrelated to CHD diagnosis in the study population was obstructive sleep apnea, which was incident in one person.
At baseline, median weight-for-age z-score (WAZ) was –0.95, height-for-age z-score (HAZ) was –1.23 and BMI z-score was –0.19, implying malnutrition, Hames and colleagues wrote.
Energy adequacy was achieved in 55 patients (92%), with most (63%) achieving adequacy by the time RRT started. These patients had a lower median WAZ (–1.17 vs. 1.24) and a lower median BMI z-score (–0.32 vs. 1.65) than patients who did not achieve adequacy. Higher WAZ score was the only predictor of energy insufficiency in multivariable analysis (OR = 0.07; 95% CI, 0.01-0.58).
Patients with insufficient maintenance fluid levels on the day they started RRT more often did not achieve energy targets (60% vs. 11% of patients without fluid restriction.
Protein adequacy was achieved in 37 patients (62%), though only 28 patients (47%) achieved adequacy for more than half of their time on RRT. Fluid restriction was the only independent predictor of protein inadequacy (OR = 0.13; 95% CI, 0.02-0.7); azotemia was not associated with protein intake.
The proportion of fluid-restricted patients did not change during RRT (15%), and 18 patients (30%) were restricted for more than half of their time on RRT. Only 30 patients (50%) achieved negative fluid balance.
According to the researchers, limitations included study design, small sample size, calculation methods, non-assessment of nitrogen levels and evaluation of energy and protein during RRT only.
Collapse
Click Here to Manage Email Alerts