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Open Access Research article

Nutritional status and clinical outcome of children on continuous renal replacement therapy: a prospective observational study

Ana Castillo1, Maria J Santiago1, Jesús López-Herce3*, Sandra Montoro1, Jorge López3, Amaya Bustinza1, Ramón Moral1 and Jose M Bellón2

Author Affiliations

1 Pediatric Intensive Care Department Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain

2 Statistics, Preventive Medicine and Quality Service Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain

3 Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, Madrid, Spain

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BMC Nephrology 2012, 13:125  doi:10.1186/1471-2369-13-125

Published: 27 September 2012

Abstract

Background

No studies on continuous renal replacement therapy (CRRT) have analyzed nutritional status in children. The objective of this study was to assess the association between mortality and nutritional status of children receiving CRRT.

Methods

Prospective observational study to analyze the nutritional status of children receiving CRRT and its association with mortality. The variables recorded were age, weight, sex, diagnosis, albumin, creatinine, urea, uric acid, severity of illness scores, CRRT-related complications, duration of admission to the pediatric intensive care unit, and mortality.

Results

The sample comprised 174 critically ill children on CRRT. The median weight of the patients was 10 kg, 35% were under percentile (P) 3, and 56% had a weight/P50 ratio of less than 0.85. Only two patients were above P95. The mean age for patients under P3 was significantly lower than that of the other patients (p = 0.03). The incidence of weight under P3 was greater in younger children (p = 0.007) and in cardiac patients and in those who had previous chronic renal insufficiency (p = 0.047). The mortality analysis did not include patients with pre-existing renal disease. Mortality was 38.9%. Mortality for patients with weight < P3 was greater than that of children with weight > P3 (51% vs 33%; p = 0.037). In the univariate and multivariate logistic regression analyses, the only factor associated with mortality was protein-energy wasting (malnutrition) (OR, 2.11; 95% CI, 1.067-4.173; p = 0.032).

Conclusions

The frequency of protein-energy wasting in children who require CRRT is high, and the frequency of obesity is low. Protein-energy wasting is more frequent in children with previous end-stage renal disease and heart disease. Underweight children present a higher mortality rate than patients with normal body weight.