Renal function in patients with intestinal failure receiving home parenteral support

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 i...

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Bibliographic Details
Published in:JPEN. Journal of parenteral and enteral nutrition 2022-02, Vol.46 (2), p.310-318
Main Authors: Mathiesen, Sophie Maria, Fuglsang, Kristian Asp, Ranzato, Giovanna, Scheike, Thomas, Jeppesen, Palle Bekker
Format: Article
Language:English
Subjects:
Creatinine
home parenteral support
Humans
Intestinal Failure
Kidney - physiology
Parenteral Nutrition
parenteral support
renal function
Retrospective Studies
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Summary: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 m2. Paired t‐test showed a decline of 15.0 ml/min/1.73 m2 (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.
ISSN:0148-6071
1941-2444
DOI:10.1002/jpen.2131