Zappitelli Michael, Goldstein Stuart L, Symons Jordan M, Somers Michael J G, Baum Michelle A, Brophy Patrick D, Blowey Douglas, Fortenberry James D, Chua Annabelle N, Flores Francisco X, Benfield Mark R, Alexander Steven R, Askenazi David, Hackbarth Richard, Bunchman Timothy E
Baylor College of Medicine, Houston, TX, USA.
Crit Care Med. 2008 Dec;36(12):3239-45. doi: 10.1097/CCM.0b013e31818f3f40.
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.
Retrospective database study.
Multicenter study in pediatric critical care units.
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.
None.
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.
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).
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.
很少有已发表的报告描述接受持续肾脏替代治疗的急性肾损伤危重症儿童和青年的营养供应情况。本研究的目的是描述儿科持续肾脏替代治疗中的喂养实践，并评估与蛋白质和热量处方过量及不足相关的因素。
回顾性数据库研究。
儿科重症监护病房的多中心研究。
前瞻性儿科持续肾脏替代治疗注册研究中纳入的急性肾损伤患者（持续肾脏替代治疗开始时估计肾小球滤过率<75 mL/min/1.73 m²）。
无。
营养变量：初始和最大蛋白质（g/kg/天）及热量（kcal/kg/天）处方以及预测静息能量消耗（kcal/kg/天）。我们通过多变量分析确定了预测初始和最大蛋白质及热量处方的因素。
对195例患者（年龄中位数[四分位间距]=8.1[12.8]岁，56.9%为男性）进行了研究。持续肾脏替代治疗开始时的平均蛋白质和热量处方分别为1.3±1.5 g/kg/天（中位数为1.0；范围为0 - 10）和37±27 kcal/kg/天（中位数为32；范围为0 - 107）。持续肾脏替代治疗期间的平均最大蛋白质和热量处方分别为2.0±1.5 g/kg/天（中位数为1.7；范围为0 - 12）和48±32 kcal/kg/天（中位数为43；范围为0 - 117）。34%的患者初始蛋白质处方<1 g/kg/天；23%的患者从未达到>1 g/kg/天的蛋白质处方。到持续肾脏替代治疗第5天，规定的蛋白质中位数>2 g/kg/天。各医疗中心的蛋白质处方实践差异很大，10个中心中有5个中心在≥40%的患者中实现了>2 g/kg/天的最大蛋白质处方。热量处方超过预测静息能量消耗30% - 100%与持续肾脏替代治疗期间最大蛋白质和热量处方独立相关的因素是年龄较小、初始蛋白质和热量处方以及持续肾脏替代治疗天数（p<0.05）。
儿科持续肾脏替代治疗中的蛋白质处方可能不足。营养处方存在中心间差异。儿科急性肾损伤营养方面的喂养实践标准化和研究对于开始提供基于证据的喂养建议至关重要。
