Continuous renal replacement therapy amino acid, trace metal and folate clearance in critically ill children.
OBJECTIVE
We hypothesized continuous veno-venous hemodialysis (CVVHD) amino acid, trace metals and folate clearance impacts nutrient balance.


METHODS
Critically ill children receiving CVVHD were studied prospectively for 5 days. Blood concentrations (amino acids, copper, zinc, manganese, chromium, selenium and folate) were measured at CVVHD initiation, and Days 2 and 5. CVVHD clearance, losses and nutrient balances were calculated on Days 2 and 5.


RESULTS
We studied 15 children aged 7.7 +/- 6.7 years. Nitrogen balance was negative on Days 2 and 5. Amino acid clearances ranged from 2.8 to 51.1 ml/min per 1.73 m(2). CVVHD losses corresponded to 20% of intake. Days 2 and 5 balances were negative for selenium, but positive for other trace metals. Folate clearance was 16 ml/min per 1.73 m(2) on Days 2 and 5 and serum concentrations decreased significantly from initiation to Day 5 (P < 0.05).


CONCLUSIONS
Nutrient losses by CVHHD may impact adequate nutrition provision.
Zappitelli
Michael
M
Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Juarez
Marisa
M
Castillo
L
L
Coss-Bu
Jorge
J
Goldstein
Stuart L
SL
D000293:Adolescent; D000596:Amino Acids / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D002149:Energy Intake; D005260:Female; D005492:Folic Acid / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008657:Metabolic Clearance Rate / Q000502:physiology*; D008670:Metals / Q000378:metabolism*; D009752:Nutritional Status; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods; D051437:Renal Insufficiency / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000379:methods*; D014131:Trace Elements / Q000378:metabolism*; D014815:Vitamins; D055815:Young Adult
D000596:Amino Acids; D008670:Metals; D014131:Trace Elements; D014815:Vitamins; D005492:Folic Acid