BACKGROUND In critically ill children with acute kidney injury (AKI), continuous kidney replacement therapy (CKRT) enables nutrition provision. The magnitude of amino acid loss during continuous venovenous hemodiafiltration (CVVHDF) is unknown and needs accurate quantification. We investigated the mass removal and clearance of amino acids in pediatric CVVHDF. METHODS This is a prospective observational cohort study of patients receiving CVVHDF from August 2014 to January 2016 in the pediatric intensive care unit (PICU) of a tertiary children's hospital. RESULTS Fifteen patients (40% male, median age 2.0 (IQR 0.7, 8.0) years) were enrolled. Median PICU and hospital lengths of stay were 20 (9, 59) and 36 (22, 132) days, respectively. Overall survival to discharge was 66.7%. Median daily protein prescription was 2.00 (1.25, 2.80) g/kg/day. Median daily amino acid mass removal was 299.0 (174.9, 452.0) mg/kg body weight, and median daily amino acid mass clearance was 18.2 (13.5, 27.9) ml/min/m2, resulting in a median 14.6 (8.3, 26.7) % protein loss. The rate of amino acid loss increased with increasing dialysis dose and blood flow rate. CONCLUSION CVVHDF prescription and related amino acid loss impact nutrition provision, with 14.6% of the prescribed protein removed. Current recommendations for protein provision for children requiring CVVHDF should be adjusted to compensate for circuit-related loss. A higher resolution version of the Graphical abstract is available as Supplementary information.

中文翻译：

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连续静脉-静脉血液透析滤过对儿童氨基酸输送、清除和清除的影响。

背景 在患有急性肾损伤 (AKI) 的危重儿童中，连续肾脏替代疗法 (CKRT) 能够提供营养。连续静脉血液透析滤过 (CVVHDF) 过程中氨基酸损失的程度未知，需要准确量化。我们研究了小儿 CVVHDF 中氨基酸的大量去除和清除。方法 这是一项前瞻性观察性队列研究，对象为 2014 年 8 月至 2016 年 1 月在一家三级儿童医院儿科重症监护病房 (PICU) 接受 CVVHDF 的患者。结果 15 名患者（40% 为男性，中位年龄 2.0 (IQR 0.7, 8.0) 岁）入组。中位 PICU 和住院时间分别为 20 (9, 59) 和 36 (22, 132) 天。出院总生存率为 66.7%。每日蛋白质处方中位数为 2.00 (1.25, 2.80) g/kg/天。平均每日氨基酸质量清除率为 299.0 (174.9, 452.0) mg/kg 体重，平均每日氨基酸质量清除率为 18.2 (13.5, 27.9) ml/min/m2，中位数为 14.6 (8.3, 26.7) %蛋白质损失。氨基酸丢失率随着透析剂量和血流量的增加而增加。结论 CVVHDF 处方和相关氨基酸损失影响营养供应，14.6% 的处方蛋白质被去除。应调整当前为需要 CVVHDF 的儿童提供蛋白质的建议，以补偿与电路相关的损失。图形摘要的更高分辨率版本可作为补充信息。7) % 蛋白质损失。氨基酸丢失率随着透析剂量和血流量的增加而增加。结论 CVVHDF 处方和相关氨基酸损失影响营养供应，14.6% 的处方蛋白质被去除。应调整当前为需要 CVVHDF 的儿童提供蛋白质的建议，以补偿与电路相关的损失。图形摘要的更高分辨率版本可作为补充信息。7) % 蛋白质损失。氨基酸丢失率随着透析剂量和血流量的增加而增加。结论 CVVHDF 处方和相关氨基酸损失影响营养供应，14.6% 的处方蛋白质被去除。应调整当前为需要 CVVHDF 的儿童提供蛋白质的建议，以补偿与电路相关的损失。图形摘要的更高分辨率版本可作为补充信息。