1. Feeding Modality is a Barrier to Providing Adequate Protein to Pediatric Patients Receiving Continuous Renal Replacement Therapy
Molly Wong Vega, MS, RDN
Marisa Juarez, MPH, RDN; Sarah Swartz, MD, Poyyapakkam Srivaths, MD; Helen Currier, BSN, RN; Ayse Akcan-Arikan, MD

2. Introduction Higher protein provision benefits patients receiving CRRT
Higher protein needs in pediatrics
Losses + growth
12 month retrospective review at our institution
Only 54% patients met protein goals within 7 days of CRRT initiation
Nutrition identified as primary monitoring metric in quality improvement program
Castillo et al. BMC Nephrology 2012;13:
Abel et al. N Engl J Med 1973;288:
Maxvold et al. Crit Care Med 2000; 28(4):
Zappitelli et al. Intensive Care Med 2009;35(4):
Scheinkestel et al. Nutrition 2003;19:733:740

3. Introduction
Development of quality improvement program focusing on acute renal extracorporeal therapies
Interdisciplinary
Continuous quality improvement cycle
Thrice weekly bedside quality improvement rounds
Analysis of individual prescriptions revealed changes in protein amount received when delivery method changed
Hypothesis: feeding modality may be a factor limiting protein provision

4. Methods
Daily prospective monitoring of pts on CRRT performed over 10 months
Nutrition Parameters:
Nutrition prescription
Nutrition delivery
Feeding modality
Nutrition status
Minimum goal defined as 2.5 grams/kg/day
Exclusion criteria:
<2 days receiving CRRT
Inborn errors of metabolism
All CVVHDF : Continuous Veno-Venous Hemodiaultrafiltration

5. Results Demographics N=42 patients 5 received CRRT with ECMO
3 received extracorporeal liver support-albumin dialysis
Mean age: 8.9 ± 6.9 years (27 male, 15 female)
Mean CRRT duration: 15.2 ± 15.5 days (range:2-89 days)
18 patients were malnourished via anthropometric criteria
Most common treatments indications: clearance & fluid removal

6. Results Mean protein prescription: 2 ± 0.94 grams/kg/d
Mean protein delivery: 1.8 ± 0.93 grams/kg/d
30 patients (69%) met goal protein prescription at least 1 time while receiving CRRT
12 never met goal protein prescription
1 never fed

7. Results
Decreased to 19% for those weaned from Combination of TPN + tube/oral to full tube/oral
(N=17) (p<0.001)
TPN + Tube/oral N = 22; full wean N = 17
TPN only N = 14
Tube/oral N = 5
None = 1

8. Conclusion Protein provision continues lower than goal levels
Achievement of protein goals varied by delivery modality
Tube/oral feeding modalities receive the lowest amounts of protein
Parenteral to enteral transition was identified as period of nutritional risk

9. Thank you! Questions?
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