Continuous venovenous hemodiafiltration trace element clearance in pediatric patients: a case series

Abstract

Continuous renal replacement therapy (CRRT) is used to treat critically ill children with acute kidney injury. The effect of CRRT on trace element clearance is poorly characterized. The purpose of this study was to quantify the transmembrane clearance of chromium, copper, manganese, selenium and zinc during continuous venovenous hemodiafiltration (CVVHDF). The transmembrane clearance of trace elements was assessed prospectively in five critically ill children receiving CVVHDF at the pediatric intensive care unit of a tertiary care university hospital. Pre-filter blood and effluent samples were measured for trace element concentrations. Transmembrane clearance of trace elements was calculated, and daily loss of each trace element was determined. Daily trace element loss via CVVHDF was compared with daily standard supplementation of trace elements in pediatric parenteral nutrition. Five patients (age range 23 months to 15 years) with a body weight range of 10.5-53 kg completed the study. The median transmembrane clearance of chromium, copper, manganese, selenium and zinc during CVVHDF was calculated as 0 ml, 0.59 ml, 2.48 ml, 1.22 ml, and 1.90 ml, respectively, per 1.73 m(2) body surface area per minute. The calculated CVVHDF losses were substantially smaller than the daily parenteral supplementation for all trace elements.

Elimination Rates of Electrolytes, Vitamins, and Trace Elements during Continuous Renal Replacement Therapy with Citrate Continuous Veno-Venous Hemodialysis: Influence of Filter Lifetime

“…CRRT removes waste products, but also medications and nutrients [8,9] through the processes of filtration and dialysis [9]. Limited data are available concerning CRRT-induced loss of nutritional substrates, vitamins, and trace elements [10,11]. Losses of trace elements are likely to occur because they are small in size and thus dialyze readily [9].…”

Nutritional management in the critically ill child with acute kidney injury: a review

“…Based on folate levels in the patients of the Tapy et al study [54], it is possible that additional folate supplementation is needed in children who are receiving CRRT for prolonged periods. It has been suggested that the recommended daily allowances should be provided and that watersoluble vitamin, trace element and folate levels be strictly monitored in children receiving prolonged RRT [57,69].…”

Neonatal Extracorporeal Life Support: A Review of Nutrition Considerations

“…Increased protein provision is likely necessary for neonatal ECLS patients if CRRT is utilized. Other CRRT‐mediated losses may occur, including the loss of trace minerals, key nutrients, and water‐soluble vitamins, and the clinical significance of these losses remains unknown . Guidelines for PN provision exist for adult patients with renal failure and include recommendations regarding supplementation when CRRT is utilized; however, no such guidelines exist for neonates .…”