Protein/energy debt in critically ill children in the pediatric intensive care unit: acute kidney injury as a major risk factor.
Acute kidney injury (AKI) is common in pediatric intensive care unit (PICU) patients. In this clinical setting, the risk of protein-energy wasting is high because of the metabolic derangements of the uremic syndrome, the difficulties in nutrient needs estimation, and the possible negative effects of renal replacement therapy itself on nutrient balance. No specific guidelines on nutritional support in PICU patients with AKI are currently available. The present review is aimed at evaluating the role of AKI as a risk condition for inadequate protein/energy intake in these patients, on the basis of literature data on quantitative aspects of nutritional support in PICU. Current evidence suggests that a relevant protein/energy debt, a widely accepted concept in the literature on adult intensive care unit patients with its negative implications for patients' major outcomes, is also likely to develop in pediatric critically ill patients, and that AKI represents a key factor for its development.
Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Medical School, Parma, Italy.
Alice
A
Sabatino
Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Medical School, Parma, Italy.
Giuseppe
G
Regolisti
Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Medical School, Parma, Italy.
Umberto
U
Maggiore
Department of Clinical and Experimental Medicine, Acute and Chronic Renal Failure Unit, Parma University Medical School, Parma, Italy. Electronic address: enrico.fiaccadori@unipr.it.
Enrico
E
Fiaccadori
D058186:Acute Kidney Injury / Q000628:therapy*; D002153:Calorimetry, Indirect; D002648:Child; D016638:Critical Illness / Q000628:therapy*; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D006801:Humans; D015278:Intensive Care Units, Pediatric; D009751:Nutritional Requirements; D018529:Nutritional Support; D064167:Recommended Dietary Allowances; D017582:Renal Replacement Therapy; D012307:Risk Factors
D004044:Dietary Proteins