Kidney Week

Abstract: FR-PO467

Renal and Metabolic Complications of Long-Term Total Parental Nutrition (TPN) in Pediatric Patients

Session Information

• CKD: Risk Factors for Incidence and Progression - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 301 CKD: Risk Factors for Incidence and Progression

Authors

• Baddi, Poornima, Children's hospital of Michigan, Detroit, Michigan, United States

Poornima Baddi,

• Zoubi, Najeeb, Children''s hospital of Michigan, Detroit, Michigan, United States

Najeeb Zoubi,

• Lelli, Joseph L, Children''s Hospital of Michigan, Detroit, Michigan, United States

Joseph L Lelli,

• Mattoo, Tej K., Children's Hospital of Michigan, Detroit, Michigan, United States

Tej K. Mattoo,

Group or Team Name

• Wayne state university

Background

The number of children requiring prolonged TPN is increasing and yet very little is known about its potential long term complications. The objective of this study was to evaluate renal and metabolic complications of prolonged TPN in patients at our institution.

Methods

We did a retrospective chart review with prospective follow-up of 26 patients who, with the exception of one patient, were followed at our Children’s hospital Intestinal Rehabilitation Program (CHIRP) clinic. We included patients 1 to 15 (median of 4) years of age that had been on TPN for > 6 months at the time of data collection. Patients who received <20% of nutrition as TPN and those with other co-morbidities were excluded. Variables that were studied included anthropometric data, indication and duration of TPN, TPN formulation and daily volume, intestinal anatomy, details on oral nutritional supplements, current medications, blood and urine chemistry results, renal imaging results, and number of acute kidney injury (AKI) episodes.

Results

Of the 26 patients, 8 (31%) received 100% nutrition as TPN; 10 (38%) patients received a mean of 80% and 8 received 20%-80% nutrition as TPN. The Median duration of TPN administration was 4 years (Range 1-15). Recurrent AKI was the commonest complication in 24 (92%) patients with a median of 8 (range 4 - 40) episodes per patient. Other complications were hypertension (38%), echogenic kidneys on ultrasound examination (27%), renal size asymmetry (15%), hydronephrosis (15%), renal calculi (11%), phosphaturia, hypophosphatemia and nephrocalcinosis (4%), and recurrent post-infectious Glomerulonephritis (4%). Glomerular hyper filtration, as defined by modified Schwartz eGFR of >135ml/min/m², was noted in 12 (46%) patients.

Conclusion

Children on long-term TPN are at risk of CKD due to recurrent AKI, hypertension, and glomerular hyperfiltration. Appropriate renal and metabolic monitoring is recommended.