Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Clinical Nutrition

Background:

• Nutrition is crucial for critically ill children, especially those with acute kidney injury (AKI).
• Lack of established guidelines for pediatric AKI patients undergoing continuous renal replacement therapy (CRRT) necessitates clear nutritional strategies.
• Understanding metabolic changes and nutritional challenges in AKI and CRRT is essential for effective management.

Purpose of the Study:

• To develop clinical practice points for the nutritional assessment and management of critically ill children with AKI receiving CRRT.
• To provide evidence-based recommendations for optimizing nutrition therapy in this vulnerable pediatric population.

Main Methods:

• A comprehensive literature search was conducted across PubMed, MEDLINE, Cochrane, and Embase databases for articles up to January 2023.
• Expert consensus from a multidisciplinary workgroup, including pediatric nephrologists and nutritionists, was utilized.
• The modified Delphi method was employed to refine and finalize the clinical practice points.

Main Results:

• A thorough review of existing literature was performed by a panel of pediatric nephrology and nutrition experts.
• The expert panel synthesized literature findings with their clinical expertise to formulate practice recommendations.
• The modified Delphi method facilitated a consensus-driven approach to identify and refine key clinical practice points.

Conclusions:

• Forty-four clinical practice points have been established for nutrition assessment and management in pediatric AKI patients on CRRT.
• These points cover crucial aspects including energy requirements and nutrient intake.
• The guidelines are based on current literature and the collective expertise of a multidisciplinary panel.