Micronutrient deficiencies in continuous renal replacement therapy: A literature review and the emerging role of the pharmacist
Calise Wang, Patricia Kaarto, Nicholas Farina, Michelle Schultz, Laura Burr, Sarah NordbeckAbstract
Purpose
Evaluating micronutrient deficiencies in the critically ill population is challenging given the complex clinical picture for many patients. Continuous renal replacement therapy (CRRT) is a risk factor for micronutrient deficiencies in this cohort, with deficiencies resulting from increased losses in dialysis effluent or adsorption to tubing or to the dialysis filter. The aim of this article is to summarize pertinent research literature regarding micronutrient supplementation and monitoring in CRRT and identify areas for pharmacists to improve patient outcomes from a nutrition standpoint.
Summary
A computerized literature search was conducted of the PubMed electronic database, and articles were included if they discussed one of the prespecified micronutrients and renal replacement therapy. The micronutrients specifically addressed in this article are copper, selenium, zinc, L-carnitine, vitamin C, vitamin B1, vitamin B6, and vitamin B9. For each of these micronutrients, we summarize the evidence for deficiencies in CRRT and supplementation strategies. However, in many cases, literature is lacking to support supplementation and monitoring strategies specifically in CRRT.
Conclusion
Current literature recognizes that standard supplementation may not be enough in the critically ill population on CRRT, but evidence is lacking for optimal micronutrient supplementation doses and monitoring parameters. Until future literature is available, pharmacists should be aware of these deficiencies and help guide recommendations for supplementation.