Official Sections CTRMS ISVCA IPITA IPTA ISODP IRTA IXA SPLIT TID

2013 - ISBTS 2013 Symposium


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Oral Communications 2

8.219 - Chronic renal failure in patients on long term home parenteral nutrition and in intestinal transplant recipients

Presenter: Loris, Pironi, , Italy
Authors: Loris Pironi1, Augusto Lauro2, Valentina Soverini1, Chiara Zanfi2, Federica Agostini1, Mariacristina Guidetti1, Caterina Pazzeschi1, Antonio D Pinna2

Chronic renal failure in patients on long term home parenteral nutrition and in intestinal transplant recipients

Loris Pironi1, Augusto Lauro2, Valentina Soverini1, Chiara Zanfi2, Federica Agostini1, Mariacristina Guidetti1, Caterina Pazzeschi1, Antonio D Pinna2

1Center for Chronic Intestinal Failure, University of Bologna, Bologna, Italy; 2Transplantation Unit, University of Bologna, Bologna, Italy

Intestinal transplantation (ITx) is the solid organ transplant at higher risk for developing chronic renal failure (CRF) [1]. One study demonstrated a decrease of renal function associated with home parenteral nutrition (HPN) [2]. The occurrence of frequent and severe episodes of dehydration, notwithstanding optimal HPN,  potentially causing CRF, is a Medicare indication criteria for ITx [3]. We investigated the renal function before and after HPN or ITx in patients currently cared at the same Hospital.
 
Methods. A cross-sectional and retrospective follow up study was carried out in patients meeting the following enrollment criteria: age >18 and ≤ 60 years, duration of treatment ≥ 6 months, living at home. Renal function was evaluated at time of enrollment (cross sectional) and was compared with that observed at time of starting HPN or ITx (retrospective follow up), as recorded in the patient records: serum creatinine concentration (mg/dL) and glomerular filtration rate (GFR), estimated according to the MDRD equation (ml/min/1.73 m2).  CRF was defined as GFR < 60. Duration of follow up was from time of starting HPN or ITx to time of cross sectional. Statistical analysis by Student’s T-test and Chi-square test.
 
Results. Thirty-three HPN patients and 22 ITx recipients were enrolled: females were 20 and 7 (P=0.03), and mean age was 43 and 32 years (p=0.00), respectively. At time of starting treatment, mean creatinine  was  0.82 and 0.83 (P=0.88), mean GFR was 101 and 115 (p=0.21), and frequency of CRF was 6% and 9% (P=0.67),in HPN and ITx respectively. Mean duration of follow up was 101 months in HPN and 74 in ITx (p=0.15). At time of cross sectional, creatinine was higher (P=0.00), GFR was lower (P=0.03), %decrease of GFR was higher (p=0.00) and frequency of CRF was higher (p=0.10) in ITx. The yearly decline of GFR was 2.8% in HPN and 14.5% in ITx (p=0.02).
 
Conclusions. The decrease of renal function and the risk of developing CRF are greater after ITx than during long-term HPN.


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