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Continuous venovenous hemodiafiltration trace element clearance in pediatric patients: a case series

Deborah A Pasko1, Mariann D Churchwell, Imad F Btaiche

  • 1Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109-1065, USA.

Pediatric Nephrology (Berlin, Germany)
|January 22, 2009
PubMed

Insights

Continuous renal replacement therapy (CRRT) significantly clears minimal trace elements in critically ill children. Daily losses during continuous venovenous hemodiafiltration (CVVHDF) are less than standard supplementation.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Trace Element Metabolism

Background:

  • Continuous renal replacement therapy (CRRT) is essential for critically ill children with acute kidney injury.
  • The impact of CRRT on trace element removal remains inadequately understood.
  • This study quantifies trace element transmembrane clearance during continuous venovenous hemodiafiltration (CVVHDF).

Observation:

  • Trace element concentrations (chromium, copper, manganese, selenium, zinc) were measured in pre-filter blood and effluent.
  • Transmembrane clearance and daily losses of these elements were calculated in five pediatric patients undergoing CVVHDF.
  • Clearance rates were normalized to body surface area per minute.

Findings:

  • Median transmembrane clearance rates (per 1.73 m(2)/min) were: chromium 0 ml, copper 0.59 ml, manganese 2.48 ml, selenium 1.22 ml, and zinc 1.90 ml.
  • Daily trace element losses via CVVHDF were substantially lower than standard pediatric parenteral nutrition supplementation for all measured elements.
  • This suggests CRRT does not lead to significant depletion of these essential trace elements.

Implications:

  • CRRT, specifically CVVHDF, demonstrates minimal clearance of key trace elements in pediatric patients.
  • Current trace element supplementation in parenteral nutrition may be adequate, even during CVVHDF.
  • Further research should confirm these findings and explore potential adjustments to supplementation protocols.

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