Incidence of Impaired Kidney Function Among Adolescent Patients Hospitalized With Anorexia Nervosa

Gurevich, Evgenia; Steiling, Shelly; Landau, Daniel

doi:10.1001/jamanetworkopen.2021.34908

Cited by 9 publications

(10 citation statements)

References 26 publications

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“…As previously reported (Gurevich et al, 2021; Stheneur et al, 2019), eGFR was low in a large proportion of our adolescent and young adult patients with restrictive EDs hospitalized for nutritional support. This proportion, while high, is likely an underrepresentation of the true extent of kidney dysfunction in this population since serum creatinine concentrations depend on muscle mass, which is particularly low in malnourished individuals.…”

Section: Discussionsupporting

confidence: 84%

“…Thirty‐three percent of patients ( n = 23) demonstrated a serum bicarbonate concentration above the normal range (i.e., above 29 mEq/L) at some point in their admission. Urine pH did not increase during these episodes, however; urine pH values were 7 (Casiero & Frishman, 2006; Gurevich et al, 2021) when serum bicarbonate concentrations were increased. A linear mixed model demonstrated that net fluid balance, hospital day, and the interaction between hospital day and net fluid balance were independent predictors of serum bicarbonate concentration during hospitalization (Table 2).…”

Section: Resultsmentioning

confidence: 91%

“…Cardiac, endocrine, vascular, and neurological complications have been well described (Casiero & Frishman, 2006). Impaired kidney function has also been described in up to one third of patients hospitalized for malnutrition (Gurevich et al, 2021; Stheneur et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Renal fluid and acid/base balance during refeeding in restrictive eating disorders

Rosen

Wiley

Hung

et al. 2022

Intl J Eating Disorders

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Background and Objectives: Fluid shifts have been ascribed to central diabetes insipidus in patients with anorexia nervosa hospitalized for refeeding. Recent data, however, suggest that vasopressin production is not dysregulated in this population. Our objective was to describe the trajectory of fluid imbalances in relationship to kidney function, electrolyte disturbances, and acid/base balance during refeeding. Methods: A retrospective review of daily fluid balance and biochemical values was performed in 70 sequential unique patients admitted to University of California at Los Angeles Hospital Medical Stabilization Program for Eating Disorders from December 2018 to November 2020.Results: Participants (2 males/68 females) were between 10 and 24 years of age and with a median body mass index of 16.1 (14.3, 18.1) kg/m 2 . A severe negative fluid balance (>À900 ml/day) was observed in 80% of patients at some point during hospitalization.Serum sodium concentrations were normal on admission and remained stable during refeeding. Serum bicarbonate concentrations were 25 ± 1 mEq/dl on admission and increased above the normal range in 31% of patients. Metabolic alkalosis was inversely associated with the development of a negative fluid balance. Estimated glomerular filtration rate was impaired in 54% of patients, improved with refeeding, and was not associated with the development of a severe negative fluid balance or metabolic alkalosis.Discussion: Chronic energy deprivation alters the physiology of renal fluid and bicarbonate handling in ways that are independent of vasopressin and glomerular filtration. Further studies are warranted to understand the renal adaptations that occur during energy restriction and subsequent refeeding.Public Significance: Massive urinary fluid losses occur in patients with restrictive eating disorders hospitalized for refeeding. In addition, many patients have impaired renal bicarbonate excretion. These findings suggest that chronic energy deprivation impairs the kidney's ability to handle the shifts in fluid and acid/base balance that occur when appropriate oral nutrition is re-introduced.

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Section: Discussionsupporting

confidence: 84%

Section: Resultsmentioning

confidence: 91%

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Renal fluid and acid/base balance during refeeding in restrictive eating disorders

Rosen

Wiley

Hung

et al. 2022

Intl J Eating Disorders

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“…Reduced hepatic function could have additional consequences for skeletal muscle size and function given the liver is a significant moderator of whole body and amino acid metabolism, and thus, important for muscle metabolic health. Altered renal function has also been noted in patients with AN (Gurevich et al, 2021). Finally, immune function, appears modified in patients with AN.…”

Section: Discussionmentioning

confidence: 99%

Anorexia nervosa and muscle health: A systematic review of our current understanding and future recommendations for study

Rosa‐Caldwell

Eddy

Rutkove

et al. 2022

Intl J Eating Disorders

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Objective: Conduct a systematic review on muscle size and strength in individuals with anorexia nervosa (AN).Method: In accordance with PRISMA guidelines, we searched Pubmed for articles published between 1995 and 2022 using a combination of search terms related to AN and muscle size, strength, or metabolism. After two authors screened articles and extracted data, 30 articles met inclusion criteria. Data were coded, and a risk bias was conducted for each study. Results: The majority of studies focused on muscle size/lean mass (60%, n = 18) and energy expenditure (33%, n = 9), with few studies (17%, n = 5) investigating muscle function or possible mechanisms underlying muscle size (20%, n = 6). Studies supported that individuals with AN have smaller muscle size and reduced energy expenditure relative to controls. In some studies (33%, n = 10) recovery from AN was not sufficient to restore muscle mass or function. Mechanisms underlying short and longterm musculoskeletal alterations have not been thoroughly explored. Discussion: Muscle mass and strength loss may be an unexplored component of physiological deterioration during and after AN. More research is necessary to understand intramuscular alterations during AN and interventions to facilitate muscle mass and functional gain following weight restoration in AN. Public Significance: Muscle health is important for optimal health and is reduced in individuals with AN. However, we do not understand how muscle is altered at the cellular level throughout the course of AN. Here we review what is currently known regarding muscle health during AN and with weight restoration. RésuméObjetivo: Realizar una revisión sistemática sobre el tamaño y la fuerza muscular en individuos que padecen anorexia nerviosa (AN).Método: De acuerdo con las guías PRISMA, se realizaron búsquedas en Pubmed de artículos publicados entre 1995 y 2022 mediante una combinación de términos de búsqueda relacionados con la anorexia nerviosa y el tamaño, la fuerza o el metabolismo muscular. Después de que dos autores examinaron los artículos y extrajeron los

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“…Abnormalities in kidney function and electrolyte disturbances are frequently seen in patients with ED, including acute kidney injury (AKI) and chronic kidney disease (CKD) [ 4 ], most often related to chronic hypokalemia (serum potassium < 3.5 mEq/L) and volume depletion [ 5 ]. AKI is a “heterogeneous group of conditions characterized by a sudden decrease in glomerular filtration rate (GFR) followed by an increase in serum creatinine concentration or oliguria [low urine output]” which can lead to serious complications including volume overload and electrolyte abnormalities and can progress to CKD [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Renal and electrolyte complications in eating disorders: a comprehensive review

Puckett

2023

J Eat Disord

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Eating disorders are psychiatric disorders with significant and widespread medical complications, including renal disorders. Renal disease is not uncommon in patients with eating disorders but is often unrecognized. It includes both acute renal injury and progression to chronic kidney disease requiring dialysis. Electrolyte abnormalities including hyponatremia, hypokalemia, and metabolic alkalosis are common in eating disorders and vary depending on whether patients engage in purging behaviors. Chronic hypokalemia due to purging in patients with anorexia nervosa-binge purge subtype or bulimia nervosa can lead to hypokalemic nephropathy and chronic kidney disease. Additional electrolyte derangements are seen during refeeding, including hypophosphatemia, hypokalemia, and hypomagnesemia. Patients can also develop Pseudo-Bartter’s syndrome which leads to edema and rapid weight gain in patients who cease purging behavior. Clinicians and patients should be aware of these complications in order to provide education and early detection and prevention.

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Incidence of Impaired Kidney Function Among Adolescent Patients Hospitalized With Anorexia Nervosa

Cited by 9 publications

References 26 publications

Renal fluid and acid/base balance during refeeding in restrictive eating disorders

Renal fluid and acid/base balance during refeeding in restrictive eating disorders

Anorexia nervosa and muscle health: A systematic review of our current understanding and future recommendations for study

Renal and electrolyte complications in eating disorders: a comprehensive review

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