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Published on: July 3, 2013
Fluid Restriction Contributes to Poor Nutritional Adequacy in Patients With Congenital Heart Disease Receiving Renal
Daniel L Hames1, Lynn A Sleeper2, Michael A Ferguson3
1Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Insights
Inadequate protein delivery affects 38% of pediatric cardiac intensive care unit patients on renal replacement therapy. Fluid restriction and higher weight-for-age z-scores are linked to poor nutrition in these critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Nephrology
- Pediatric Cardiology
Background:
- Critically ill children with congenital heart disease requiring renal replacement therapy (RRT) face significant nutritional challenges.
- Inadequate nutrition delivery is a known risk factor for adverse outcomes in this vulnerable population.
- Understanding barriers to optimal nutrition is crucial for improving patient care.
Purpose of the Study:
- To identify barriers to adequate energy and protein delivery in pediatric patients with congenital heart disease receiving RRT.
- To evaluate the relationship between patient characteristics and nutritional adequacy during RRT.
- To inform strategies for optimizing nutritional support in this cohort.
Main Methods:
- A single-center retrospective cohort study was conducted from 2011 to 2019.
- Energy and protein intake adequacy (>80% of targets) was assessed within the first 7 days of RRT.
- Multivariable logistic regression identified factors associated with nutritional adequacy.
Main Results:
- Ninety-two percent achieved energy adequacy, while 62% achieved protein adequacy.
- Higher weight-for-age z-score (WAZ) on admission predicted inadequate energy intake.
- Fluid restriction was independently associated with inadequate protein intake.
Conclusions:
- Nearly 40% of pediatric RRT patients in the CICU experienced inadequate protein delivery.
- Higher WAZ and fluid restriction emerged as key factors hindering adequate nutrition.
- Optimizing fluid management and considering nutritional status at admission are vital for these patients.
Objectives:
Critically ill patients receiving renal replacement therapy (RRT) in the pediatric cardiac intensive care unit (CICU) are at high risk for inadequate nutrition delivery. The objective of this study is to evaluate barriers to adequate energy and protein delivery in critically ill patients with congenital heart disease receiving RRT.
Methods:
This is a single-center retrospective cohort study of patients receiving RRT in the CICU from 2011 to 2019. Energy and protein adequacy was recorded over the first 7 days of RRT. Adequacy was defined as delivery of >80% of the energy and protein targets during this time period. Patients who achieved adequacy were compared to those who did not. Multivariable logistic regression models were constructed to determine factors independently associated with energy and protein adequacy while receiving RRT.
Results:
Sixty patients were included for analysis. Fifty-five patients (92%) achieved energy adequacy and 37 patients (62%) achieved protein adequacy. A higher weight-for-age z-score (WAZ) on admission to the CICU was the only independent predictor of inadequate energy intake (odds ratio 0.07, 95% confidence interval 0.01-0.58, P = .014); median WAZ was -1.17 versus +1.24 for those with adequate versus inadequate energy intake, respectively. Fluid restriction to <80% of maintenance fluid at the time of RRT initiation was more likely in patients with higher WAZ. Fluid restriction was the only independent predictor of inadequate protein intake (odds ratio 0.13, 95% confidence interval 0.02-0.7, P = .018); 5% versus 30% were fluid restricted in those with adequate versus inadequate protein intake, respectively. Azotemia was not associated with inadequate protein intake. Initiation of RRT did not allow for liberalization of fluid intake over the time period evaluated.
Conclusions:
Protein delivery was inadequate in 38% of children undergoing RRT in the CICU. Fluid restriction was associated with inadequate protein intake and higher WAZ was associated with inadequate energy intake.
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