Quality Improvement Bedside Rounding Audits Enhance Protein Provision for Pediatric Patients Receiving Continuous Renal Replacement Therapy*

Vega, Molly Wong; Juarez, Marisa; Lee, Ji Yeon; Srivaths, Poyyapakkam; Williams, Eric A.; Akcan-Arikan, Ayse

doi:10.1097/pcc.0000000000001698

Cited by 10 publications

(3 citation statements)

References 14 publications

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“…Malnutrition and protein energy wasting are prevalent and independently associated with mortality in children hospitalized with AKI, especially those requiring paKST, with prevalence ranging from 30% to 55%. [108][109][110][111] Mortality is a crude end point to assess the importance of nutrition support in children with AKI. AKI survivors are at risk of worsened functional status, chronic ventilation, or dialysis after hospital discharge.…”

Section: Consensus Statement 5b (Recommendation)mentioning

confidence: 99%

Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

et al. 2022

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ImportanceIncreasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge.ObjectiveTo develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy.Evidence ReviewAt the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations.FindingsThe meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy.Conclusions and RelevanceExisting evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts.

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Section: Consensus Statement 5b (Recommendation)mentioning

confidence: 99%

Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

et al. 2022

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“…Rationale: The prevalence of malnutrition in hospitalized children ranges between 6 and 32%, depending on the country [5]. Children with the most severe AKI, requiring continuous kidney replacement therapy (CKRT), have reported malnutrition rates between 30 and 55% [6][7][8][9]. Fluid and electrolyte restrictions limit the selection of commonly consumed foods by children and impact nutritional status.…”

Section: Clinical Practice Recommendations and Rationalementioning

confidence: 99%

Nutritional management of children with acute kidney injury—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

et al. 2023

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The nutritional management of children with acute kidney injury (AKI) is complex. The dynamic nature of AKI necessitates frequent nutritional assessments and adjustments in management. Dietitians providing medical nutrition therapies to this patient population must consider the interaction of medical treatments and AKI status to effectively support both the nutrition status of patients with AKI as well as limit adverse metabolic derangements associated with inappropriately prescribed nutrition support. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPR) for the nutritional management of children with AKI. We address the need for intensive collaboration between dietitians and physicians so that nutritional management is optimized in line with AKI medical treatments. We focus on key challenges faced by dietitians regarding nutrition assessment. Furthermore, we address how nutrition support should be provided to children with AKI while taking into account the effect of various medical treatment modalities of AKI on nutritional needs. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. CPRs will be regularly audited and updated by the PRNT.

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“…Malnutrition and protein energy wasting is common in hospitalized children with AKI, with a prevalence rate of 30-55% in children receiving CKRT [4,[41][42][43]. Nutritional management may prevent worsening nutritional status in children with AKI, persistent AKI, and AKD.…”

Section: Optimal Nutritional Management Work In Concert With Pharmaco...mentioning

confidence: 99%

Advances in pediatric acute kidney injury pharmacology and nutrition: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

Wong Vega,

Starr,

Brophy

et al. 2023

Pediatr Nephrol

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Background In the past decade, there have been substantial advances in our understanding of pediatric AKI. Despite this progress, large gaps remain in our understanding of pharmacology and nutritional therapy in pediatric AKI. Methods During the 26th Acute Disease Quality Initiative (ADQI) Consensus Conference, a multidisciplinary group of experts reviewed the evidence and used a modified Delphi process to achieve consensus on recommendations for gaps and advances in care for pharmacologic and nutritional management of pediatric AKI. The current evidence as well as gaps and opportunities were discussed, and recommendations were summarized. Results Two consensus statements were developed. (1) High-value, kidney-eliminated medications should be selected for a detailed characterization of their pharmacokinetics, pharmacodynamics, and pharmaco-“omics” in sick children across the developmental continuum. This will allow for the optimization of real-time modeling with the goal of improving patient care. Nephrotoxin stewardship will be identified as an organizational priority and supported with necessary resources and infrastructure. (2) Patient-centered outcomes (functional status, quality of life, and optimal growth and development) must drive targeted nutritional interventions to optimize short- and long-term nutrition. Measures of acute and chronic changes of anthropometrics, body composition, physical function, and metabolic control should be incorporated into nutritional assessments. Conclusions Neonates and children have unique metabolic and growth parameters compared to adult patients. Strategic investments in multidisciplinary translational research efforts are required to fill the knowledge gaps in nutritional requirements and pharmacological best practices for children with or at risk for AKI.

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Quality Improvement Bedside Rounding Audits Enhance Protein Provision for Pediatric Patients Receiving Continuous Renal Replacement Therapy*

Abstract: Implementation of an interprofessional quality improvement team significantly decreased number of continuous renal replacement therapy days with unmet protein goals and improved protein delivery.

Cited by 10 publications

References 14 publications

Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

Nutritional management of children with acute kidney injury—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

Advances in pediatric acute kidney injury pharmacology and nutrition: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

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