OBJECTIVES: Nutrition plays a vital role in the outcome of critical illness in children, particularly those with acute kidney injury. Currently, there are no established guidelines for children with acute kidney injury treated with continuous kidney replacement therapy. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with acute kidney injury receiving continuous kidney replacement therapy. METHODS: An electronic search using PubMed and an inclusive academic library search (including MEDLINE, Cochrane, and Embase databases) was conducted to find relevant English-language articles on nutrition therapy for children (<18 y of age) receiving continuous kidney replacement therapy. RESULTS: The existing literature was reviewed by our work group, comprising pediatric nephrologists and experts in nutrition. The modified Delphi method was then used to develop a total of 45 clinical practice points. The best methods for nutritional assessment are discussed. Indirect calorimetry is the most reliable method of predicting resting energy expenditure in children on continuous kidney replacement therapy. Schofield equations can be used when indirect calorimetry is not available. The non-intentional calories contributed by continuous kidney replacement therapy should also be accounted for during caloric dosing. Protein supplementation should be increased to account for the proteins, peptides, and amino acids lost with continuous kidney replacement therapy. CONCLUSIONS: Clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with acute kidney injury and on continuous kidney replacement therapy based on the existing literature and expert opinions of a multidisciplinary panel.

Akron Children's Hospital Akron Ohio USA

Akron Nephrology Associates Cleveland Clinic Akron General Akron Ohio USA

Akron Nephrology Associates Cleveland Clinic Akron General Akron Ohio USA; Akron Children's Hospital Akron Ohio USA

Children's Hospital Colorado University of Colorado Section of Pediatric Nephrology Aurora Colorado USA

Department of Paediatrics Yong Loo Lin School of Medicine National University of Singapore Singapore

Department of Pediatric Nephrology Kidney Institute Medanta The Medicity Gurgaon India

Department of Pediatrics 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Pediatrics Children's Hospital of Richmond Virginia Commonwealth University Richmond Virginia USA

Division of Nephrology and Dialysis Department of Pediatrics Bambino Gesù Children's Hospital and Research Institute Rome Italy

Division of Pediatric Nephrology Department of Pediatrics Le Bonheur Children's Hospital and St Jude Children's Research Hospital University of Tennessee Health Science Center Memphis Tennessee USA

Division of Pediatric Nephrology East Tennessee Children's Hospital Knoxville Tennessee USA; Department of Medicine University of Tennessee Knoxville Tennessee USA

Johns Hopkins Bayview Medical Center Baltimore Maryland USA

Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA; Children's Healthcare of Atlanta Atlanta Georgia USA; ECU Health Greenville North Carolina USA

Pediatrics Department College of Medicine King Saud University Riyadh Kingdom of Saudi Arabia

UCL Department of Renal Medicine Royal Free Hospital University College London London UK

University of Pennsylvania School of Nursing Philadelphia Pennsylvania USA; Children's Hospital of Philadelphia Philadelphia Pennsylvania USA

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