Abstract: SA-OR068
Early Enteral Failure Predicts Survival in Children Receiving CRRT
Session Information
- Innovations in Pediatric Nephrology and Kidney Development
November 08, 2025 | Location: Room 371A, Convention Center
Abstract Time: 05:10 PM - 05:20 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Vega, Molly RW, Baylor College of Medicine, Houston, Texas, United States
- Juarez, Marisa D., Texas Children's Hospital, Houston, Texas, United States
- Thadani, Sameer, Baylor College of Medicine, Houston, Texas, United States
- Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
Background
Optimal protein delivery in critically ill children requiring continuous renal replacement therapy (CRRT) remains challenging, with enteral (EN) and parenteral (PN) nutrition presenting distinct risks. The longitudinal relationship between protein sources, intake patterns, and outcomes in pediatric CRRT requires systematic evaluation.
Methods
We analyzed 7,200 CRRT-days from 302 children (mean age 8±7.7 years), including 29.5% with malnutrition. All patients received CVVHDF with initial clearance prescription of 2000 mL/1.73m2/hr. Linear mixed-effects models evaluated: (1) source-specific protein contributions, (2) enteral ratio (EN/[EN+PN]) trajectories by mortality status, and (3) early (≤7 days) versus late (>7 days) phase differences.
Results
The median CRRT duration was 13 days (IQR 6–26.2), with cumulative mortality rates of 23.5%, 32.1%, and 37.7% at 30, 60, and 90 days, respectively. Weighted mean protein intake was 2.69±0.94 g/kg/day (EN: 0.32±0.42; PN: 2.36±1.14). Early enteral nutrition failure—defined as not achieving >10% of total protein intake from EN by Day 7—was a strong predictor of mortality. Each 1% increase in EN ratio was associated with an 8% decrease in the odds of death (OR 0.92, 95% CI: 0.88–0.96; p < 0.001). Survivors showed progressive EN advancement, increasing from 0.28 ± 0.3 to 0.73 ± 0.6 g/kg/day (EN ratio: 13.7% to 27.1%, β = +0.134, p < 0.001), while non-survivors maintained persistently low EN (EN ratio: 5.4% to 9.9%, β = -0.089 interaction, p < 0.001), with higher PN at baseline (2.51 ± 1.2 vs. 2.21 ± 1.0 g/kg/day, p = 0.006) and greater PN dependence (0.12 vs. 0.03 g/kg/day/week increase, p < 0.001).
Conclusion
Early enteral failure (<10% EN ratio by Day 7) and PN dependence characterize high-risk pediatric CRRT patients. These findings support protocolized EN advancement and early identification of enteral intolerance, with serial EN/PN tracking offering a clinically actionable tool for risk stratification and targeted nutritional interventions.