Renal function in patients with intestinal failure receiving home parenteral support
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Renal function in patients with intestinal failure receiving home parenteral support. / Mathiesen, Sophie Maria; Fuglsang, Kristian Asp; Ranzato, Giovanna; Scheike, Thomas; Jeppesen, Palle Bekker.
In: Journal of Parenteral and Enteral Nutrition, Vol. 46, No. 2, 2022, p. 310-318.Research output: Contribution to journal › Journal article › Research › peer-review
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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 -
ID: 272708715