Nutrition support among critically ill children with AKI

Clin J Am Soc Nephrol. 2013 Apr;8(4):568-74. doi: 10.2215/CJN.05790612. Epub 2013 Jan 4.


Background: Critically ill children are at high risk of underfeeding and AKI, which may lead to further nutritional deficiencies. This study aimed to determine the adequacy of nutrition support during the first 5 days of intensive care unit (ICU) stay.

Design, setting, participants, & measurements: A chart review of pediatric patients admitted to the pediatric ICU for >72 hours between August 2007 and March 2008 was conducted. Patients were classified as having no AKI versus AKI by modified pediatric RIFLE criteria. All nutrition was analyzed. Basal metabolic rate (BMR) was estimated by the Schofield equation and protein needs by American Society for Parenteral and Enteral Nutrition guidelines.

Results: Of the 167 patients, 102 were male and 65 were female (median age 1.4 years). Using the RIFLE criteria, 102 (61%) patients had no AKI, whereas 44 (26%) were classified as category R (risk), 12 (7%) as category I (injury), and 9 (5%) as category F (failure). The median 5-day energy intake was lower relative to estimated BMR. Overall protein provision (19%) was lower than energy provision (55%) compared with estimated needs (P<0.001). I/F patients were more likely to be fasted versus receiving enteral/parenteral nutrition (n=813 patient days) and to receive <90% of BMR (n=832 patient days) than No AKI/R patients.

Conclusions: Underfeeding, common in critically ill children, was accentuated in AKI. Protein underfeeding was greater than energy underfeeding in the first 5 days of PICU stay. Efforts should be made to provide adequate nutrition in ICU patients with AKI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / diet therapy*
  • Child
  • Child Nutrition Disorders / diet therapy
  • Child Nutrition Disorders / prevention & control*
  • Child Nutritional Physiological Phenomena*
  • Child, Preschool
  • Critical Illness / therapy*
  • Dietary Proteins / administration & dosage
  • Energy Metabolism
  • Female
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Male
  • Nutrition Assessment
  • Protein-Energy Malnutrition / diet therapy
  • Protein-Energy Malnutrition / prevention & control*
  • Retrospective Studies


  • Dietary Proteins