Abstract: TH-PO927
Descriptive Analysis of Renal Function and Potential Renal Acid Load in Adult Patients with Long-term Home Parenteral Nutrition Support: A Retrospective Study
Session Information
- Health Maintenance, Nutrition, Metabolism - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Author
- Thimachai, Paramat, University of Alberta, Edmonton, Canada
Background
Home parenteral nutrition (HPN) is an established therapy for chronic intestinal failure (CIF). The relationship between CIF and HPN with renal function and kidney disease has yet to be well described in this population. Our study aims to describe chronic kidney disease (CKD) with renal function and potential acidosis load in patients who received long-term HPN.
Methods
We conducted a retrospective study in Edmonton, Alberta. Adult patients aged ≥18 who visited the HPN clinic between Jan 2022 and Mar 2023 were enrolled. The patient admitted to the program for less than six months was excluded. Electronic medical records were reviewed for five years to collect demographic data, the presence of CIF, HPN indications and prescription, the presence of CKD and renal functions. The primary outcome was the estimated glomerular filtration rate (eGFR) with its change after admission to the program and potential total acids load (PTAL). Secondary outcomes included predicted pH, amino acids, glucose, lipid, electrolytes, trace elements, acetate concentration and estimated osmolality load in TPN prescription.
Results
Sixty-one adult patients were included in the study. The mean age was 59.20 ± 11.51 years old, 27.9 % were male and short bowel syndrome was noted in 59%; the most common cause of short bowel syndrome was Crohn's disease. Diabetes mellitus was 16.4 %, Hypertension was 39.3%, and CKD was 47.5%. The most common cause of CKD was nephrolithiasis. The duration of HPN was 6.03 years. An average eGFR was 84.51 ± 27.09 ml/min/1.73 m2 with a mean change of -2.69 ± 3.21 ml/min/1.73 m2/year, and the incident rate of rapid GFR decline was 27.9% in five-year follow-up. The median amount of amino acids was 1.19 (0.85, 1.55) g/kg/day. The average pH of the TPN solution was 5.33 ± 0.36. The median of PTAL was 71.43 (48.35, 95.05) mmol/bag without statistical correlation with CKD when normalised by body weight.
Conclusion
The prevalence of CKD in the HPN was higher than in the general population, with a high rate of eGFR decline. The study showed no statistical correlation between PTAL and CKD in those patients. A prospective study with different GFR measurements should be conducted for the accuracy of eGFR and to demonstrate risk factors for the deterioration of renal function.
Funding
- Government Support – Non-U.S.