TY - JOUR

T1 - Renal function in patients with intestinal failure receiving home parenteral support

AU - Mathiesen, Sophie Maria

AU - Fuglsang, Kristian Asp

AU - Ranzato, Giovanna

AU - Scheike, Thomas

AU - Jeppesen, Palle Bekker

PY - 2022

Y1 - 2022

N2 - Background Progressive renal impairment, given by an annual decline in estimated glomerular filtration rate (eGFR), has been described in patients with intestinal failure (IF) receiving home parenteral support (HPS). The objective of this study was to examine changes in eGFR over 5 years following initiation of HPS treatment and to identify potential risk factors for loss of renal function.Method This retrospective database study investigates eGFR changes in nonmalignant IF patients discharged with HPS from Rigshospitalet, Copenhagen, in an 8-year period.Results One year after HPS initiation, mean eGFR decreased by 15.3 ml/min/1.73 m(2). Paired t-test showed a decline of 15.0 ml/min/1.73 m(2) (95% CI, -18.3 to -11.6; P < .0001). Over the following years, eGFR continued to decrease but at insignificant lower rates. Decreased eGFR was associated with increasing age, female sex, increasing body weight, diabetes at HPS initiation, and a high requirement of HPS volume.Conclusion In nonmalignant IF patients, the decrease of eGFR was mainly seen during the first year of HPS. This may be due to a higher risk of dehydration and possibly secondary hyperaldosteronism leading to renal damage following the onset of IF. However, the decrease in eGFR may also represent a higher production of creatinine due to a beneficial increase of muscle mass in the initial recovery phase. In general, once the patients were stabilized, the eGFR decline followed a physiological course resembling the background population. Patients with diabetes or high HPS volume needs seem to be more vulnerable and may require special attention.

AB - Background Progressive renal impairment, given by an annual decline in estimated glomerular filtration rate (eGFR), has been described in patients with intestinal failure (IF) receiving home parenteral support (HPS). The objective of this study was to examine changes in eGFR over 5 years following initiation of HPS treatment and to identify potential risk factors for loss of renal function.Method This retrospective database study investigates eGFR changes in nonmalignant IF patients discharged with HPS from Rigshospitalet, Copenhagen, in an 8-year period.Results One year after HPS initiation, mean eGFR decreased by 15.3 ml/min/1.73 m(2). Paired t-test showed a decline of 15.0 ml/min/1.73 m(2) (95% CI, -18.3 to -11.6; P < .0001). Over the following years, eGFR continued to decrease but at insignificant lower rates. Decreased eGFR was associated with increasing age, female sex, increasing body weight, diabetes at HPS initiation, and a high requirement of HPS volume.Conclusion In nonmalignant IF patients, the decrease of eGFR was mainly seen during the first year of HPS. This may be due to a higher risk of dehydration and possibly secondary hyperaldosteronism leading to renal damage following the onset of IF. However, the decrease in eGFR may also represent a higher production of creatinine due to a beneficial increase of muscle mass in the initial recovery phase. In general, once the patients were stabilized, the eGFR decline followed a physiological course resembling the background population. Patients with diabetes or high HPS volume needs seem to be more vulnerable and may require special attention.

KW - home parenteral support

KW - intestinal failure

KW - parenteral support

KW - renal function

KW - MUSCLE MASS

KW - DEHYDRATION

KW - MECHANISMS

KW - DAMAGE

KW - HYPERTENSION

KW - NEPHROPATHY

U2 - 10.1002/jpen.2131

DO - 10.1002/jpen.2131

M3 - Journal article

C2 - 33914343

VL - 46

SP - 310

EP - 318

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

SN - 0148-6071

IS - 2

ER -