Nutrition delivery in infants with kidney failure on extracorporeal kidney replacement therapy

Infants with kidney failure who initiate kidney replacement therapy (KRT) within 3 months of life require optimal fluid and nutritional management to support growth. Continuous or prolonged intermittent KRT (CKRT or PIKRT) is often used as a bridge to peritoneal dialysis facilitating earlier nutrition provision but is associated with protein losses. Current guidelines recommend ≥ 3-3.5 g/kg/day of protein during KRT. We aimed to assess nutritional prescriptions and growth in these infants.

We conducted a retrospective review of infants with kidney failure managed with extracorporeal KRT at Lucile Packard Children's Hospital between January 2021 and December 2024. Demographics, dialysis dose, nutrition prescriptions, anthropometry, and laboratory values were collected weekly from birth through 8 weeks and at discharge.

Seventeen infants were included; 12 (71%) were female. KRT was initiated at a median age of 3 days and a median weight of 2110 g. Initial modality was PIKRT in 15 (88%) and CKRT in 2 (12%). The median prescribed protein was 2.7 g/kg/day in Week 1, increasing to 4 g/kg/day by Week 6. Caloric prescriptions rose from 95 kcal/kg/day in Week 1 to 136 kcal/kg/day by Week 8. Median z-scores for weight, length, and head circumference decreased from birth to Week 8 (weight - 1.07 to - 1.34; length - 1.02 to - 1.95; head circumference - 0.41 to - 1.36), with discharge values of - 1.08, - 1.73, and - 1.40.

Despite early KRT and nutritional optimization, infants showed limited catch-up growth. Early provision of ≥ 4 g/kg/day protein and ≥ 130 kcal/kg/day may prevent cumulative deficits.