Federica Agostini1, Anna Simona Sasdelli2, Mariacristina Guidetti2, Giorgia Comai3, Gaetano La Manna4, Loris Pironi5. 1. Center for Chronic Intestinal Failure, St Orsola Hospital, University of Bologna, Bologna, Italy; School of Medicine of the University of Bologna, Bologna, Italy. 2. Center for Chronic Intestinal Failure, St Orsola Hospital, University of Bologna, Bologna, Italy. 3. Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy. 4. School of Medicine of the University of Bologna, Bologna, Italy; Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy. 5. Center for Chronic Intestinal Failure, St Orsola Hospital, University of Bologna, Bologna, Italy. Electronic address: Loris.pironi@unibo.it.
Abstract
OBJECTIVE: The aim of this study was to evaluate kidney function outcome in adults on home parenteral nutrition (HPN) for chronic intestinal failure using the newly recommended equations for estimated glomerular filtration rate (eGFR) assessment in clinical practice. METHODS: This was an observational study with 72 patients. Clinical and biochemical parameters were collected at initiation of HPN (retrospective baseline [BL]), at inclusion in the study (cross-sectional [CS]), and at the end of a 30-mo prospective follow-up (Fup). The eGFR (mL/min/1.73 m2 body surface) was calculated by the Chronic Kidney Disease Epidemiology Collaboration creatinine and categorized as normal, mildly decreased (MDKF), and chronic kidney disease (CKD) when ≥90, 60 to 89, and <60, respectively. RESULTS: An eGFR<90 was observed in 41.7% of patients at BL, 53.4% at CS, and 56.6% at Fup. A CKD was present in all of the patients at BL, 20.1% at CS, and 35.9% at Fup. The probability of maintaining an eGFR ≥60 was 98%, 82%, and 79% at 1, 5, and 10 y after BL, respectively (Kaplan-Meier analysis). The probability was lower in patients with MDKF at BL (P = 0.039). The development of a CKD was significantly associated with aging and urologic diseases and numerically associated with the episodes of venous-catheter sepsis, short bowel syndrome, and a low volume of HPN. CONCLUSIONS: In patients on HPN for chronic intestinal failure, decreased kidney function is a frequent finding, even at HPN commencement, demanding accurate monitoring during the treatment. Prevention of CKD primarily relies on the maintenance of fluid balance and the prevention of catheter-sepsis and urologic diseases.
OBJECTIVE: The aim of this study was to evaluate kidney function outcome in adults on home parenteral nutrition (HPN) for chronic intestinal failure using the newly recommended equations for estimated glomerular filtration rate (eGFR) assessment in clinical practice. METHODS: This was an observational study with 72 patients. Clinical and biochemical parameters were collected at initiation of HPN (retrospective baseline [BL]), at inclusion in the study (cross-sectional [CS]), and at the end of a 30-mo prospective follow-up (Fup). The eGFR (mL/min/1.73 m2 body surface) was calculated by the Chronic Kidney Disease Epidemiology Collaboration creatinine and categorized as normal, mildly decreased (MDKF), and chronic kidney disease (CKD) when ≥90, 60 to 89, and <60, respectively. RESULTS: An eGFR<90 was observed in 41.7% of patients at BL, 53.4% at CS, and 56.6% at Fup. A CKD was present in all of the patients at BL, 20.1% at CS, and 35.9% at Fup. The probability of maintaining an eGFR ≥60 was 98%, 82%, and 79% at 1, 5, and 10 y after BL, respectively (Kaplan-Meier analysis). The probability was lower in patients with MDKF at BL (P = 0.039). The development of a CKD was significantly associated with aging and urologic diseases and numerically associated with the episodes of venous-catheter sepsis, short bowel syndrome, and a low volume of HPN. CONCLUSIONS: In patients on HPN for chronic intestinal failure, decreased kidney function is a frequent finding, even at HPN commencement, demanding accurate monitoring during the treatment. Prevention of CKD primarily relies on the maintenance of fluid balance and the prevention of catheter-sepsis and urologic diseases.