Continuous venovenous hemodiafiltration trace element clearance in pediatric patients: a case series

Continuous renal replacement therapy (CRRT) is used to treat critically ill children with acute kidney injury. The effect of CRRT on trace element clearance is poorly characterized. The purpose of this study was to quantify the transmembrane clearance of chromium, copper, manganese, selenium and zinc during continuous venovenous hemodiafiltration (CVVHDF). The transmembrane clearance of trace elements was assessed prospectively in five critically ill children receiving CVVHDF at the pediatric intensive care unit of a tertiary care university hospital. Pre-filter blood and effluent samples were measured for trace element concentrations. Transmembrane clearance of trace elements was calculated, and daily loss of each trace element was determined. Daily trace element loss via CVVHDF was compared with daily standard supplementation of trace elements in pediatric parenteral nutrition. Five patients (age range 23 months to 15 years) with a body weight range of 10.5–53 kg completed the study. The median transmembrane clearance of chromium, copper, manganese, selenium and zinc during CVVHDF was calculated as 0 ml, 0.59 ml, 2.48 ml, 1.22 ml, and 1.90 ml, respectively, per 1.73 m² body surface area per minute. The calculated CVVHDF losses were substantially smaller than the daily parenteral supplementation for all trace elements. These data were presented in poster form at the 2006 International Continuous Renal Replacement Therapy Meeting, San Diego, CA, USA. Abstract reference: Pasko DA, Churchwell MD, Btaiche IF, Jain JC, Mueller BA (2006) Trace element clearance in pediatric patients supported by continuous venovenous hemodiafiltration (CVVHDF). Blood Purif 24:269 (abstract no. 49). This study was funded in part by a grant from the University of Michigan College of Pharmacy Clinical Research Resources Fund.