Submitted to: Intensive Care Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/7/2008
Publication Date: 4/1/2009
Citation: Zappitelli, M., Juarez, M., Castillo, L., Coss-Bu, J., Goldstein, S.L. 2009. Continuous renal replacement therapy amino acid, trace metal and folate clearance in critically ill children. Intensive Care Medicine. 35(4):698-706. Interpretive Summary: To reduce the loss of nutrients in patients with renal failure who are undergoing dialysis, a mixture of amino acids and trace minerals are often infused along with the dialysis fluid. However, this practice has not been thoroughly evaluated. To do so, we determined nutrient balances in children (ages 1-21 years) receiving continuous renal replacement therapy. This study shows that nutrient losses with continuous renal replacement therapy may be considerable and may impact adequate provision of nutrients. Such findings are important and could impact strategies to improve nutrient maintenance.
Technical Abstract: We hypothesized that continuous veno-venous hemodialysis (CVVHD) results in amino acid, trace metals, and folate losses, thereby adversely impacting nutrient balance. Critically ill children receiving CVVHD were studied prospectively for 5 days. Blood concentrations, amino acids, copper, zinc, manganese, chromium, selenium, and folate were measured at CVVHD initiation and Days 2 and 5. CVVHD clearance, losses, and nutrient balances were calculated on Days 2 and 5 in 15 children aged 7.7 +/- 6.7 years. Nitrogen balance was negative on days 2 and 5. Amino acid clearances ranged from 2.8 to 51.1 ml/min per 1.73 m2. CVVHD losses of amino acids corresponded to 20% of intake. Days 2 and 5 balances were negative for selenium, but positive for other trace metals. Folate clearance was 16 ml/min per 1.73 m2 on days 2 and 5 and serum concentrations decreased significantly from initiation to day 5 (P +/- 0.05).