Renal Function in Children on Long Term Home Parenteral Nutrition

Abstract

Objectives: To assess renal function in pediatric intestinal failure (IF) patients on long term home parenteral nutrition (HPN). Methods: Children who received HPN for a minimum of 3 years between 2007 and 2017 were identified from the IF clinic of a large tertiary referral center. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula at discharge on HPN, after 6 months, 1, 2, and 3 years. Results: Twenty five patients (40% male) fulfilled the inclusion criteria. The indications for HPN were due to an underlying motility disorder in 56% (14/25), enteropathy in 24% (6/25), and short bowel syndrome in 20% (5/25). At the start of HPN 80% (20/25) had a normal eGFR. Four children (17%) had an abnormal eGFR. In the group of patients with normal eGFR at the start of HPN 30% (6/20) had at least one episode of decreased eGFR in the following 3 years, however there was no significant decline in eGFR at the end of the 3 year study period. Overall there was no statistically significant deterioration of eGFR in the study population ( p = 0.7898). Conclusion: In our cohort of children on long term HPN no significant decline of eGFR could be demonstrated within 3 years of starting PN.

Children with Intestinal Failure Maintain Their Renal Function on Long-Term Parenteral Nutrition

“…In Ylinen's study, a decreased eGFR was associated with longer PN duration and a lower percentage of remaining small bowel length in SBS patients. In contrast to these early findings, the results from our study are in concordance with some more recent publications; a study by Messova et al [24] found no significant deterioration of eGFR over a three-year period among Nutrients 2021, 13, 3647 7 of 10 25 pediatric IF patients, and a study by Roberts et al [11] also demonstrated preserved eGFR over a two-year period in pediatric IF. The discordance from studies demonstrating reduced renal function could be related to the era in which they were conducted, suggesting a more favorable outcome of home PN treatment nowadays.…”

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

“…The duration of PN was inversely correlated with the true GFR (r = −0.66, P < 0.01) (142). More recent observations did not conirm such impaired renal function (143)(144)(145)(146). However, cyclical PN may predispose to disturbed renal function by signiicantly changing the water-electrolyte homeostasis over each 24 hours period with intravascular volume depletion if there are also high intestinal luid losses, hemodynamic instability episodes as well as repeated episodes of dehydration with hypercalcemia that might predispose to nephrocalcinosis or even renal failure (143).…”

“…This risk seems to be mostly related to calcium levels (150,151) and to growth failure (17,152) which is more prevalent in other forms of IF rather than in SBS (153). Length of remnant bowel, higher PN dependency, and longer duration of PN do not seem to impact on MBD development (11,146). DXA monitoring for SBS-IF children should be promoted especially in presence of serum calcium, phosphorus, or parathormone alterations.…”

“…A recent study concluded that despite the high prevalence of hypercalciuria, nephrocalcinosis was not common (144). Many of these complications are avoidable with, for example maintenance of adequate hydration, regular surveillance of renal function and personalized adjustments of PN managed by a multidisciplinary nutrition support team (144,146). Base line and long‐term monitoring of various aspects of renal function would be essential to characterize the effects of prolonged PN on kidney function.…”