Feeding Modality is a Barrier to Providing Adequate Protein to Pediatric Patients Receiving Continuous Renal Replacement Therapy Molly Wong Vega, MS, RDN.

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Presentation transcript:

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

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: 125-130 Abel et al. N Engl J Med 1973;288:695-699 Maxvold et al. Crit Care Med 2000; 28(4):1161-1165 Zappitelli et al. Intensive Care Med 2009;35(4):698-706 Scheinkestel et al. Nutrition 2003;19:733:740

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

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

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

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

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

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

Thank you! Questions? Contact: mrvega@texaschildrens.org