Trace elements in patients on continuous renal replacement therapy

Broman, Marcus; Bryland, Anna; Carlsson, Ola

doi:10.1111/aas.12909

Cited by 20 publications

(23 citation statements)

References 31 publications

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“…No data exist on how this would alter outcome. Moreover, dialysis fluids contain trace elements in amounts that vary according to the fluid used . Bedside dosing in plasma would enhance the feasibility of trace‐element monitoring and management.…”

Section: Resultsmentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

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Introduction Nutrition is an important part of treatment in critically ill children. Clinical guidelines for nutrition adaptations during continuous renal replacement therapy (CRRT) are lacking. We collected and evaluated current knowledge on this topic and provide recommendations. Methods Questions were produced to guide the literature search in the PubMed database. Results Evidence is scarce and extrapolation from adult data was often required. CRRT has a direct and substantial impact on metabolism. Indirect calorimetry is the preferred method to assess resting energy expenditure (REE). Moderate underestimation of REE is common but not clinically relevant. Formula‐based calculation of REE is inaccurate and not validated in critically ill children on CRRT. The nutrition impact of nonintentional calories delivered as citrate, lactate, and glucose during CRRT must be considered. Quantifying nitrogen balance is not feasible during CRRT. Protein delivery should be increased by 25% to compensate for losses in the effluent. Fats are not removed by CRRT and should not be adapted during CRRT. Electrolyte disturbances are frequently present and should be treated accordingly. Vitamins B1, B6, B9, and C are lost in the effluent and should be adapted to the effluent dose. Trace elements, with the exception of selenium, are not cleared in relevant quantities. Manganese accumulation is of concern because of potential neurotoxicity. Conclusion Current recommendations regarding nutrition support in pediatric CRRT must be extrapolated from adult studies. Recommendations are provided, based on the weak level of evidence. Additional research on this topic is warranted.

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Section: Resultsmentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

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“…The most recent study showed significant losses of Cu, Fe, Se and Zn [ 9 ▪▪ ]. Broman et al [ 10 ] analysed eight elements (Cr, Cu, Co, Mn, Mo, Rb, Se, Zn), and showed that the balances were quite different: while they were negative for Cu, Se and Rb, they were positive for Cr, Mn and Zn. This was accompanied by significantly reduced plasma levels of selenium and rubidium, whilst the concentrations of chromium, cobalt and molybdenum were significantly increased.…”

Section: Introductionmentioning

confidence: 99%

“…Expert opinion and the data retrieved in this scoping review suggest that water-soluble vitamins should be administered routinely during CRRT, but controversy exists about the optimal dosage, timing, and duration [ 45 – 47 ]. Recommendations from experts [ 10 – 14 , 17 ], official societies [ 48 ] and authorities vary [ 22 , 46 , 49 ▪▪ , 50 , 51 ]. A recent review on nutrition therapy during CRRT in critically ill children proves a dearth of information and shares weak recommendations [ 52 ].…”

Section: Introductionmentioning

confidence: 99%

Nutrients and micronutrients at risk during renal replacement therapy: a scoping review

Berger

Broman

Forni

et al. 2021

Current Opinion in Critical Care

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Purpose of review Malnutrition is frequent in patients with acute kidney injury. Nutrient clearance during renal replacement therapy (RRT) potentially contributes to this complication. Although losses of amino acid, trace elements and vitamins have been described, there is no clear guidance regarding the role of micronutrient supplementation. Recent findings A scoping review was conducted with the aim to review the existing literature on micronutrients status during RRT: 35 publications including data on effluent losses and blood concentrations were considered relevant and analysed. For completeness, we also included data on amino acids. Among trace elements, negative balances have been shown for copper and selenium: low blood levels seem to indicate potential deficiency. Smaller size water soluble vitamins were found in the effluent, but not larger size liposoluble vitamins. Low blood values were frequently reported for thiamine, folate and vitamin C, as well as for carnitine. All amino acids were detectable in effluent fluid. Duration of RRT was associated with decreasing blood values. Summary Losses of several micronutrients and amino acids associated with low blood levels represent a real risk of deficiency for vitamins B1 and C, copper and selenium: they should be monitored in prolonged RRT. Further Research is urgently required as the data are insufficient to generate strong conclusions and prescription recommendations for clinical practice.

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“…The mechanisms of these alterations in micronutrients are not clear, but their impact on outcomes in pediatric ECMO may be important and require further investigation. In patients receiving ECMO who also require dialysis, micronutrient losses may be further compounded, because continuous renal replacement therapy has been associated with loss of ionized calcium, inorganic phosphorus, and selenium, among other trace elements . These observations may have implications for micronutrient supplementation in the pediatric ECMO population, and attempts to monitor micronutrients should be made.…”

Section: Nutrition Requirements During Pediatric Ecmomentioning

confidence: 99%

Nutrition Support During Pediatric Extracorporeal Membrane Oxygenation

2018

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Providing adequate nutrition to critically ill pediatric patients is essential and positively impacts outcomes. Critically ill infants and children receiving extracorporeal membrane oxygenation (ECMO) therapy are nutritionally vulnerable, yet there are challenges to reliable assessment of nutrition requirements and to the delivery of optimal nutrition in this cohort. In this review of the relevant literature, we present the current evidence and guidelines for the optimal prescription and delivery of nutrition for pediatric patients receiving ECMO. We also discuss nutrient delivery considerations in ECMO survivors and identify areas where further study is needed. (Nutr Clin Pract. 2018;33:747-753)

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Trace elements in patients on continuous renal replacement therapy

Cited by 20 publications

References 31 publications

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Nutrients and micronutrients at risk during renal replacement therapy: a scoping review

Nutrition Support During Pediatric Extracorporeal Membrane Oxygenation

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