Chronic dehydration may impair renal function in patients with chronic intestinal failure on long-term parenteral nutrition

Lauverjat, M.; Aïssa, A. Hadj; Vanhems, Philippe; Boulétreau, P; Fouque, Denis; Chambrier, C.

doi:10.1016/j.clnu.2005.09.010

Cited by 68 publications

(55 citation statements)

References 18 publications

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“…It seems that dehydration may be involved in a pathophysiological pathway that causes renal hypoperfusion [4], decreases in Glomerular filtration rate (GFR) [2] and alone may produce changes in glomerular epithelial cells, comparable to those seen in the post-ischemic kidney [5]. During this period, injury to brush border of proximal tubule cells may be present and may lead to non-detectable minimal acute tubular necrosis [6]. Although in mild dehydration only minor and, probably, reversible changes in tubular epithelial cells are apparent, dehydration as a form of prerenal acute kidney injury may be represented by a tubular enzymuria and a concomitant increase in serum Ngal [2].…”

Section: Resultsmentioning

confidence: 99%

Neutrophil gelatinase-associated lipocalin in dehydrated patients: a preliminary report

et al. 2011

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BackgroundAcute kidney injury has been recognized as a major contributor to end stage renal disease. Although neutrophil gelatinase-associated lipocalin (Ngal) has been reported as a promising biomarker for early detection of acute kidney injury, no study has yet examined its potential clinical impact in patients with normal renal function. The purpose of current study is to investigate possible difference in serum Ngal levels between dehydrated and control patients.FindingsA total of twelve patients presented with symptoms of mild dehydration defined by history of diarrheas or vomiting and orthostatic (postural) hypotension and an age and sex matched group of twelve control patients were included. The two groups of patients did not seem to differ in basic clinical and laboratory parameters. Serum Ngal was higher in dehydrated patients when compared to control group (Ngal = 129.4 ± 25.7 ng/mL vs 60.6 ± 0.4 ng/mL, p = 0.02). Ngal was not correlated with age, hemoglobin, white blood cell count, red blood cell count, urea or creatinine.ConclusionsThe presence of elevated Ngal levels in dehydrated patients may suggest its role as a very sensitive biomarker in even minimal and "silent" prerenal kidney dysfunction

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Section: Resultsmentioning

confidence: 99%

Neutrophil gelatinase-associated lipocalin in dehydrated patients: a preliminary report

et al. 2011

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“…Although urinary volume did not increase significantly in relation to GLP-2 treatment, the renal function, evaluated by the renal creatinine clearance, improved significantly in this study. Renal impairment is a documented complication in HPN patients and is at least partially due to a relative chronic dehydration [39]. Since parenteral support is frequently administered during nighttime, many short bowel patients experience relative over-hydration during nighttime and relative dehydration during daytime.…”

Section: Discussionmentioning

confidence: 99%

Short Bowel Patients Treated for Two Years with Glucagon-Like Peptide 2: Effects on Intestinal Morphology and Absorption, Renal Function, Bone and Body Composition, and Muscle Function

Jeppesen

Lund

Gottschalck

et al. 2009

Gastroenterology Research and Practice

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Background and aims. In a short-term study, Glucagon-like peptide 2 (GLP-2) has been shown to improve intestinal absorption in short bowel syndrome (SBS) patients. This study describes longitudinal changes in relation to GLP-2 treatment for two years. Methods. GLP-2, 400 micrograms, s.c.,TID, were offered, to eleven SBS patients keeping parenteral support constant. 72-hour nutritional balance studies were performed at baseline, weeks 13, 26, 52 during two years intermitted by an 8-week washout period. In addition, mucosal morphometrics, renal function (by creatinine clearance), body composition and bone mineral density (by DEXA), biochemical markers of bone turnover (by s-CTX and osteocalcin, PTH and vitamin D), and muscle function (NMR, lungfunction, exercise test) were measured. Results. GLP-2 compliance was >93%. Three of eleven patients did not complete the study. In the remaining 8 patients, GLP-2 significantly reduced the fecal wet weight from approximately 3.0 to approximately 2.0 kg/day. This was accompanied by a decline in the oral wet weight intake, maintaining intestinal wet weight absorption and urinary weight constant. Renal function improved. No significant changes were demonstrated in energy intake or absorption, and GLP-2 did not significantly affect mucosal morphology, body composition, bone mineral density or muscle function. Conclusions. GLP-2 treatment reduces fecal weight by approximately 1000 g/d and enables SBS patients to maintain their intestinal fluid and electrolyte absorption at lower oral intakes. This was accompanied by a 28% improvement in creatinine clearance.

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“…Patients with SBS who require PN are at risk of chronic dehydration and consequent renal failure [70], as well as nephrolithiasis. Nephrolithiasis may be related to dehydration as well as hyperoxaluria in the presence of colon in continuity [71].…”

Section: Home Parenteral Nutritionmentioning

confidence: 99%

Parenteral Nutrition and Intestinal Failure

Bielawska

Allard

2017

Nutrients

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Severe short bowel syndrome (SBS) is a major cause of chronic (Type 3) intestinal failure (IF) where structural and functional changes contribute to malabsorption and risk of micronutrient deficiencies. Chronic IF may be reversible, depending on anatomy and intestinal adaptation, but most patients require long-term nutritional support, generally in the form of parenteral nutrition (PN). SBS management begins with dietary changes and pharmacologic therapies taking into account individual anatomy and physiology, but these are rarely sufficient to avoid PN. New hormonal therapies targeting intestinal adaptation hold promise. Surgical options for SBS including intestinal transplant are available, but have significant limitations. Home PN (HPN) is therefore the mainstay of treatment for severe SBS. HPN involves chronic administration of macronutrients, micronutrients, fluid, and electrolytes via central venous access in the patient’s home. HPN requires careful clinical and biochemical monitoring. Main complications of HPN are related to venous access (infection, thrombosis) and metabolic complications including intestinal failure associated liver disease (IFALD). Although HPN significantly impacts quality of life, outcomes are generally good and survival is mostly determined by the underlying disease. As chronic intestinal failure is a rare disease, registries are a promising strategy for studying HPN patients to improve outcomes.

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Chronic dehydration may impair renal function in patients with chronic intestinal failure on long-term parenteral nutrition

Cited by 68 publications

References 18 publications

Neutrophil gelatinase-associated lipocalin in dehydrated patients: a preliminary report

Neutrophil gelatinase-associated lipocalin in dehydrated patients: a preliminary report

Short Bowel Patients Treated for Two Years with Glucagon-Like Peptide 2: Effects on Intestinal Morphology and Absorption, Renal Function, Bone and Body Composition, and Muscle Function

Parenteral Nutrition and Intestinal Failure

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