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01-02-2022 | Acute Kidney Injury | Original Article

The effect of continuous venovenous hemodiafiltration on amino acid delivery, clearance, and removal in children

Authors: Richard P Lion, Molly R Vega, E O’Brien Smith, Sridevi Devaraj, Michael C Braun, Nathan S Bryan, Moreshwar S Desai, Jorge A Coss-Bu, Talat Alp Ikizler, Ayse Akcan Arikan

Published in: Pediatric Nephrology | Issue 2/2022

Abstract

Background

In critically ill children with acute kidney injury (AKI), continuous kidney replacement therapy (CKRT) enables nutrition provision. The magnitude of amino acid loss during continuous venovenous hemodiafiltration (CVVHDF) is unknown and needs accurate quantification. We investigated the mass removal and clearance of amino acids in pediatric CVVHDF.

Methods

This is a prospective observational cohort study of patients receiving CVVHDF from August 2014 to January 2016 in the pediatric intensive care unit (PICU) of a tertiary children’s hospital.

Results

Fifteen patients (40% male, median age 2.0 (IQR 0.7, 8.0) years) were enrolled. Median PICU and hospital lengths of stay were 20 (9, 59) and 36 (22, 132) days, respectively. Overall survival to discharge was 66.7%. Median daily protein prescription was 2.00 (1.25, 2.80) g/kg/day. Median daily amino acid mass removal was 299.0 (174.9, 452.0) mg/kg body weight, and median daily amino acid mass clearance was 18.2 (13.5, 27.9) ml/min/m², resulting in a median 14.6 (8.3, 26.7) % protein loss. The rate of amino acid loss increased with increasing dialysis dose and blood flow rate.

Conclusion

CVVHDF prescription and related amino acid loss impact nutrition provision, with 14.6% of the prescribed protein removed. Current recommendations for protein provision for children requiring CVVHDF should be adjusted to compensate for circuit-related loss.

Graphical abstract

Available only for authorised users

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Title: The effect of continuous venovenous hemodiafiltration on amino acid delivery, clearance, and removal in children
Authors: Richard P Lion
Molly R Vega
E O’Brien Smith
Sridevi Devaraj
Michael C Braun
Nathan S Bryan
Moreshwar S Desai
Jorge A Coss-Bu
Talat Alp Ikizler
Ayse Akcan Arikan
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Acute Kidney Injury
Nutrition
Care
Acute Kidney Injury
Published in: Pediatric Nephrology / Issue 2/2022
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-021-05162-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of continuous venovenous hemodiafiltration on amino acid delivery, clearance, and removal in children

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

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