The Canadian Home Total Parenteral Nutrition (HTPN) Registry

Aljarallah, Badr; Fernandes, Gail; Jeejeebhoy, Khursheed N.; Gramlich, Leah; Whittaker, J. S.; Armstrong, David; Duerksen, D; Allard, Johane P.

doi:10.1177/0148607111431983

Cited by 13 publications

(4 citation statements)

References 29 publications

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“…HPN patients receiving vitamin K supplementation had significantly higher BMDs than patients not receiving vitamin K in their HPN solution. Therefore, vitamin K supplementation in the HPN regimen might be of benefit especially for patients with very little oral intake and no contraindication to vitamin K [24]. In our study, we did not routinely give vitamin K supplement because the majority of our HPN patients continue oral intake.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Vitamin D Insufficiency and Deficiency and Their Relationship with Bone Mineral Density and Fracture Risk in Adults Receiving Long-Term Home Parenteral Nutrition

Napartivaumnuay

Gramlich

2017

Nutrients

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It has been demonstrated that low bone mass and vitamin D deficiency occur in adult patients receiving home parenteral nutrition (HPN). The aim of this study is to determine the prevalence of vitamin D insufficiency and deficiency and its relationship with bone mineral density (BMD) and fracture risk in long-term HPN patients. Methods: A retrospective chart review of all 186 patients in the HPN registry followed by the Northern Alberta Home Parenteral Nutrition Program receiving HPN therapy >6 months with a 25 (OH) D level and BMD reported were studied. Results: The mean age at the initiation of HPN was 53.8 (20–79) years and 23 (37%) were male. The mean HPN duration was 56 (6–323) months and the most common diagnosis was short bowel syndrome. Based on a total of 186 patients, 62 patients were categorized based on serum vitamin D status as follows: 1 (24.2%) sufficient, 31 (50%) insufficient and 16 (25.8%) deficient. Despite an average of 1891 IU/day orally and 181 IU/day intravenously vitamin D, the mean vitamin D level was 25.6 ng/mL (insufficiency) and 26.2 ± 11.9 ng/mL in patients with the highest 10-year fracture risk. Conclusion: Suboptimal vitamin D levels are common among patients on long-term HPN despite nutrient intake that should meet requirements.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Vitamin D Insufficiency and Deficiency and Their Relationship with Bone Mineral Density and Fracture Risk in Adults Receiving Long-Term Home Parenteral Nutrition

Napartivaumnuay

Gramlich

2017

Nutrients

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“…To date, the database has produced publications on the topics of metabolic bone disease [82], CRBSI [83], vitamin K supplementation in relation to bone mineral density [84], HPN use in systemic sclerosis [85], manganese toxicity [86], and trace element prescription [19]. The database has also been used to study changes in HPN practice and demography [35].…”

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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“…42 In a retrospective study of 189 Canadian patients on home PN (HPN), a trend was noted for higher hip and lumbar spine t-scores for patients who had vitamin K supplementation when compared with those who had no supplementation. 48…”

Section: Treatment For Sibo and Dlamentioning

confidence: 99%

Bacteria, Bones, and Stones: Managing Complications of Short Bowel Syndrome

Johnson

Matarese

2018

Nut in Clin Prac

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Short bowel syndrome (SBS) occurs in patients who have had extensive resection. The primary physiologic consequence is malabsorption, resulting in fluid and electrolyte abnormalities and malnutrition. Nutrient digestion, absorption, and assimilation may also be diminished by disturbances in the production of bile acids and digestive enzymes. Small bowel dilation, dysmotility, loss of ileocecal valve, and anatomical changes combined with acid suppression and antimotility drugs increase the risk of small intestinal bacterial overgrowth, further contributing to malabsorption. Metabolic changes that occur in SBS due to loss of colonic regulation of gastric and small bowel function can also lead to depletion of calcium, magnesium, and vitamin D, resulting in demineralization of bone and the eventual development of bone disease. Persistent inflammation, steroid use, parenteral nutrition, chronic metabolic acidosis, and renal insufficiency may exacerbate the problem and contribute to the development of osteoporosis. Multiple factors increase the risk of nephrolithiasis in SBS. In the setting of fat malabsorption, increased free fatty acids are available to bind to calcium, resulting in an increased concentration of unbound oxalate, which is readily absorbed across the colonic mucosa where it travels to the kidney. In addition, there is an increase in colonic permeability to oxalate stemming from the effects of unabsorbed bile salts. The risk of nephrolithiasis is compounded by volume depletion, metabolic acidosis, and hypomagnesemia, resulting in a decrease in renal perfusion, urine output, pH, and citrate excretion. This review examines the causes and treatments of small intestinal bacterial overgrowth, bone demineralization, and nephrolithiasis in SBS.

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The Canadian Home Total Parenteral Nutrition (HTPN) Registry

Abstract: In HPN patients supplemented with vitamin K, the trend toward a better hip BMD compared with no supplementation suggests a role for vitamin K in preserving BMD. This requires further study.

Cited by 13 publications

References 29 publications

The Prevalence of Vitamin D Insufficiency and Deficiency and Their Relationship with Bone Mineral Density and Fracture Risk in Adults Receiving Long-Term Home Parenteral Nutrition

The Prevalence of Vitamin D Insufficiency and Deficiency and Their Relationship with Bone Mineral Density and Fracture Risk in Adults Receiving Long-Term Home Parenteral Nutrition

Parenteral Nutrition and Intestinal Failure

Bacteria, Bones, and Stones: Managing Complications of Short Bowel Syndrome

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