Adequacy of Nutritional Support in Critically Ill Children with Acute Kidney Injury

  • Ursula G. Kyle
  • Ayse Akcan-Arikana
  • Renán A. Orellana
  • Jorge A. Coss-Bu
Living reference work entry


Acute kidney injury (AKI) is a major contributory factor to overall morbidity and mortality in hospitalized patients. Management of AKI is largely supportive and should be aimed at eliminating the causative factors and preventing further damage, but the use of renal replacement therapy (RRT) is frequently required for severe AKI. AKI is caused by a sudden decline of glomerular filtration rate with an accumulation of metabolic waste products (urea), toxins, and drugs along with alterations in intrinsic function of the kidney, but it also influences nutrient substrate availability, utilization, and regulation. AKI is associated with hypercatabolism, excessive nitrogen loss, muscle wasting, hyperglycemia, hypertriglyceridemia, hypoalbuminemia, and electrolyte abnormalities. Such metabolic alterations induce protein–energy malnutrition and stunted growth in children. Underfeeding practices common in critically ill children are accentuated in AKI. Children with AKI should receive enough calories to provide 100–130 % of basal metabolic rate. Protein intake should not be restricted in AKI and should meet metabolic needs and compensate for frequent extra losses associated with RRT and proteinuria. Due to fluid overload, patients should be started on RRT in order to provide adequate nutrition. Efforts should be made to develop better nutritional assessment, to provide adequate nutrition in intensive care unit (ICU) patients with AKI, and to prospectively evaluate nutritional risk and outcomes during AKI.


Renal Replacement Therapy Acute Kidney Injury Pediatric Intensive Care Unit Nutrition Support Continuous Renal Replacement Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Acute dialysis quality initiative


Acute kidney injury


Acute kidney injury network


American Society for Parenteral and Enteral Nutrition


Basal metabolic rate


Dietary reference intake


Estimated creatinine clearance


Glomerular filtration rate


Intensive care unit


Intensive insulin therapy


Kidney Disease: Improving Global Outcomes


Resting energy expenditure


Renal replacement therapy


Serum creatinine


Total energy expenditure


World Health Organization


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ursula G. Kyle
    • 1
  • Ayse Akcan-Arikana
    • 1
    • 2
  • Renán A. Orellana
    • 1
    • 3
  • Jorge A. Coss-Bu
    • 3
  1. 1.Section of Critical Care Medicine, Department of PediatricsBaylor College of Medicine, Texas Children’s HospitalHoustonUSA
  2. 2.Renal Section, Department of PediatricsBaylor College of Medicine, Texas Children’s HospitalHoustonUSA
  3. 3.Children’s Nutrition Research Center, Department of PediatricsBaylor College of Medicine, Texas Children’s HospitalHoustonUSA

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