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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

Abstract

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.

Keywords

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.

Abbreviations

ADQI

Acute dialysis quality initiative

AKI

Acute kidney injury

AKIN

Acute kidney injury network

ASPEN

American Society for Parenteral and Enteral Nutrition

BMR

Basal metabolic rate

DRI

Dietary reference intake

eCCl

Estimated creatinine clearance

GFR

Glomerular filtration rate

ICU

Intensive care unit

ITT

Intensive insulin therapy

KDIGO

Kidney Disease: Improving Global Outcomes

REE

Resting energy expenditure

RRT

Renal replacement therapy

SCr

Serum creatinine

TEE

Total energy expenditure

WHO

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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