Feeding modality is a barrier to adequate protein provision in children receiving continuous renal replacement therapy (CRRT)

Pediatr Nephrol. 2019 Jun;34(6):1147-1150. doi: 10.1007/s00467-019-04211-z. Epub 2019 Mar 6.


Background: Critically ill children have a high prevalence of malnutrition. Children with acute kidney injury experience high rates of protein debt. Previous research has indicated that protein provision is positively associated with survival.

Methods: This was a prospective observational study of all patients receiving CRRT for greater than 48 h at our tertiary care institution. Patients with inborn errors of metabolism were excluded. Data collection included energy, protein, and fluid volume intakes, anthropometrics, feeding modality, and route of nutrition intake.

Results: Forty-one patients 9 ± 6.8 years of age, 66% male, received CRRT over a 10-month time period. CRRT treatment was 17.3 ± 25 days. Forty-one percent were malnourished via anthropometric criteria at CRRT start. Median protein delivery was 2 g/kg/day (IQR 1.4-2.5). Fifty-one percent received a combination of parenteral nutrition (PN) and enteral/oral feedings (EN), 34% received only PN, and 12% received only EN. Percentage of time meeting protein goals by modality was 27.6%, 34.6%, and 65.3% for those patients receiving solely EN, PN, and EN + PN combination, respectively. When weaned to only EN support from combination PN + EN, the average percentage of time protein goals were met decreased to 20.5% (p < 0.01).

Conclusions: Without PN, patients on enteral/oral nutrition support fail to meet appropriate protein prescription. Transition of parenteral to enteral feeds was identified as a period of nutritional risk in children receiving CRRT.

Keywords: AKI; CRRT; Enteral; Nutrition; Parenteral; Pediatrics; Protein.

Publication types

  • Observational Study

MeSH terms

  • Child
  • Child, Preschool
  • Continuous Renal Replacement Therapy / adverse effects*
  • Female
  • Humans
  • Male
  • Malnutrition / etiology*
  • Nutritional Support / methods*
  • Protein Deficiency / etiology*