PMID- 10809299
OWN - NLM
STAT- MEDLINE
DCOM- 20000525
LR  - 20190706
IS  - 0090-3493 (Print)
IS  - 0090-3493 (Linking)
VI  - 28
IP  - 4
DP  - 2000 Apr
TI  - Amino acid loss and nitrogen balance in critically ill children with acute renal 
      failure: a prospective comparison between classic hemofiltration and 
      hemofiltration with dialysis.
PG  - 1161-5
AB  - HYPOTHESIS: Amino acid (AA) loss is not equivalent on continuous venovenous 
      hemofiltration (CVVH) compared with continuous venovenous hemodiafiltration 
      (CVVHD). Amino acid supplementation may be necessary to adjust for a greater 
      clearance on CVVH to maintain nitrogen balance similar to that of CVVHD. 
      OBJECTIVE: To compare AA losses and nitrogen balance between CVVH and CVVHD in 
      children with acute renal failure. SETTING: Pediatric patients in the pediatric 
      intensive care unit of a tertiary referral center. DESIGN: Prospective randomized 
      crossover study in consecutive children who required hemofiltration. PATIENTS: A 
      total of 12 plasma clearance studies for AA and urea, consisting of 24-hr 
      collections of ultrafiltrate and urine for nitrogen balance, was performed on six 
      patients during CVVH and CVVHD. Patients received total parenteral nutrition 
      (TPN) with caloric intake 20% to 30% above their resting energy expenditure 
      measured by indirect calorimetry and 1.5 g/kg/day protein of TPN. Study 
      conditions were comprised of 2 L/hr/1.73 m2 of dialysate or prefiltered 
      replacement fluid and hemofilter flow rates of 4 mL/kg/min were maintained for 
      all patients. METHODS AND MAIN RESULTS: Amino acid clearances were greater on 
      CVVH than CWHD, except for glutamic acid, where clearance was 6.73+/-2.31 (SEM) 
      mL/min/1.73 m2 on CVVH and 7.59+/-2.79 mL/min/1.73 m2 for CVVHD (NS). The 
      clearance difference between the two modalities was 30%. Urea clearance was 
      equivalent (30.1+/-1.74 mL/min/1.73 m2 and 29.0+/-.97 mL/min/1.73 m2) for CVVH 
      and CVVHD, respectively. Amino acid loss on CVVH and CVVHD was similar 
      (12.50+/-1.29 g/day/1.73 m2 vs. 11.61+/-1.86 g/day/1.73 m2, respectively), 
      representing 12% and 11%, respectively, of the daily protein intake. The 
      catabolic state, as measured by urea nitrogen appearance, was high for all 
      patients during the 48-hr study period with a mean of 291 mg/kg/day during CVVH, 
      and 245 mg/kg/day for CVVHD. Nitrogen balance varied from a negative 12.95 
      g/day/1.73 m2 to a positive 4.93 g/day/1.73 m2 on CVVH and a negative 7.69 
      g/day/1.73 m2 to a positive 5.50 g/day/1.73 m2 on CVVHD. CONCLUSIONS: Clearance 
      of AA is greater on CVVH than on CVVHD, but no significant difference in AA loss 
      was present between the two therapies. Nitrogen balance often is not met on 
      either therapy when a standard 1.5 g/kg/day protein and a resting energy 
      expenditure of 120% to 130% of calories is delivered by TPN.
FAU - Maxvold, N J
AU  - Maxvold NJ
AD  - Division of Pediatric Critical Care Medicine, C. S. Mott Children's Hospital, 
      University of Michigan Health System, Ann Arbor, USA.
FAU - Smoyer, W E
AU  - Smoyer WE
FAU - Custer, J R
AU  - Custer JR
FAU - Bunchman, T E
AU  - Bunchman TE
LA  - eng
GR  - M01 RR00042/RR/NCRR NIH HHS/United States
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Crit Care Med
JT  - Critical care medicine
JID - 0355501
RN  - 0 (Amino Acids)
RN  - N762921K75 (Nitrogen)
SB  - IM
MH  - Acute Kidney Injury/*metabolism/therapy
MH  - Amino Acids/*analysis
MH  - Child
MH  - Child, Preschool
MH  - Critical Illness
MH  - Cross-Over Studies
MH  - Female
MH  - Hemodiafiltration/*methods/statistics & numerical data
MH  - Hemofiltration/*methods/statistics & numerical data
MH  - Humans
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Nitrogen/*analysis
MH  - Parenteral Nutrition, Total/methods
MH  - Prospective Studies
EDAT- 2000/05/16 09:00
MHDA- 2000/06/08 09:00
CRDT- 2000/05/16 09:00
PHST- 2000/05/16 09:00 [pubmed]
PHST- 2000/06/08 09:00 [medline]
PHST- 2000/05/16 09:00 [entrez]
AID - 10.1097/00003246-200004000-00041 [doi]
PST - ppublish
SO  - Crit Care Med. 2000 Apr;28(4):1161-5. doi: 10.1097/00003246-200004000-00041.