Nutrition in critically ill children with acute kidney injury on continuous kidney replacement therapy: a 2023 executive summary

Nutrition plays a vital role in the outcome of critically ill children, particularly those with acute kidney injury (AKI). Currently, there are no established guidelines for children with AKI treated with continuous kidney replacement therapy (CKRT). Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with AKI receiving CKRT. An electronic search using PubMed and an inclusive academic library search (including MEDLINE, Cochrane, and EMBASE databases) was conducted to find relevant English-language articles on Nutrition therapy for children (<18 years of age) receiving CKRT. The existing literature was reviewed by our workgroup, comprising of pediatric nephrologists and experts in nutrition. The modified Delphi method was then utilized to develop a total of 45 clinical practice points. The best methods for nutritional assessment are discussed. Indirect Calorimetry (IC) is the most reliable method of predicting resting energy expenditure (REE) in children on CKRT. Schofield equations can be used when IC is not available. The non-intentional calories contributed by CKRT should also be accounted for during caloric dosing. Protein supplementation should be increased to account for the proteins, peptides, and amino acids lost with CKRT. Clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with AKI and on CKRT based on the existing literature and expert opinions of a multidisciplinary panel.