Clearance and nutrition in neonatal continuous kidney replacement therapy using the Carpediem™ system.
Clearance and nutrition in neonatal continuous kidney replacement therapy using the Carpediem™ system.
复制标题
使用 Carpediem™ 系统进行新生儿连续肾脏替代治疗的清除和营养。
DOI：
10.1007/s00467-023-06237-w
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Joseph,Catherine
中科院分区：
文献类型：
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作者：
Vuong,KimT;Vega,MollyR;Casey,Lauren;Swartz,SarahJ;Srivaths,Poyyapakkam;Osborne,ScottW;Rhee,ChristopherJ;Arikan,AyseAkcan;Joseph,Catherine
研究背景肾衰竭（KF）婴儿生长发育不良部分是由于液体和蛋白质的限制.连续性肾脏替代治疗（CKRT）的自由化营养输送受到临床不稳定性、技术透析挑战、溶质清除和氮平衡的影响。我们分析了在2021年6月1日至12月31日期间使用Carpediem™进行CKRT的婴儿的营养和生长情况。我们收集了前瞻性的回路特征，提供营养，人体测量，新生儿急性生理学-II的疾病严重程度评分。作为维持性血液透析中标准化蛋白质分解代谢率的替代，我们使用Randerson II连续透析模型计算了标准化蛋白氮外观（nPNA）。使用SAS 9.4版进行描述性统计、斯皮尔曼相关系数、Mann Whitney、Wilcoxon符号秩和、受试者工作特征曲线和Kruskal-Wallis分析。结果8例婴儿接受了31.9（22.0，49.7）天的CKRT，主要（90%）使用局部柠檬酸盐抗凝。输送的营养量，蛋白质，总热量，肠内热量，nPNA和氮平衡增加CKRT。使用肠外营养，90毫升/公斤/天应满足热量和蛋白质的需求。在可能的液体过载的初始体重减轻后，探索性敏感性分析表明，CKRT 14天后体重增加。尽管提供了充足的营养，但直到CKRT开始后6个月才达到目标体重（z评分= 0）和生长速度。大多数（5名婴儿，62.5%）存活并过渡到腹膜透析（PD）。结论Carpediem ™是新生儿KF中安全有效的PD桥梁。尽管提供了足够的热量和蛋白质，但接受CKRT治疗的婴儿的生长速度似乎有所延迟。
BackgroundInfants with kidney failure (KF) demonstrate poor growth partly due to obligate fluid and protein restrictions. Delivery of liberalized nutrition on continuous kidney replacement therapy (CKRT) is impacted by clinical instability, technical dialysis challenges, solute clearance, and nitrogen balance. We analyzed delivered nutrition and growth in infants receiving CKRT with the Cardio-Renal, Pediatric Dialysis Emergency Machine (Carpediem™).MethodsSingle-center observational study of infants receiving CKRT with the Carpediem™ between June 1 and December 31, 2021. We collected prospective circuit characteristics, delivered nutrition, anthropometric measurements, and illness severity Score for Neonatal Acute Physiology-II. As a surrogate to normalized protein catabolic rate in maintenance hemodialysis, we calculated normalized protein nitrogen appearance (nPNA) using the Randerson II continuous dialysis model. Descriptive statistics, Spearman correlation coefficient, Mann Whitney, Wilcoxon signed rank, receiver operating characteristic curves, and Kruskal–Wallis analysis were performed using SAS version 9.4.ResultsEight infants received 31.9 (22.0, 49.7) days of CKRT using mostly (90%) regional citrate anticoagulation. Delivered nutritional volume, protein, total calories, enteral calories, nPNA, and nitrogen balance increased on CKRT. Using parenteral nutrition, 90 ml/kg/day should meet caloric and protein needs. Following initial weight loss of likely fluid overload, exploratory sensitivity analysis suggests weight gain occurred after 14 days of CKRT. Despite adequate nutritional delivery, goal weight (z-score = 0) and growth velocity were not achieved until 6 months after CKRT start. Most (5 infants, 62.5%) survived and transitioned to peritoneal dialysis (PD).ConclusionsCarpediem™ is a safe and efficacious bridge to PD in neonatal KF. Growth velocity of infants on CKRT appears delayed despite delivery of adequate calories and protein.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information