Renal function impairment in children with intestinal failure receiving parenteral nutrition: A descriptive cohort study.

Abstract

Background: Children with intestinal failure are at risk for kidney dysfunction; however, the contributing factors are not well established. We aimed to describe risk factors associated with glomerular and tubular renal dysfunction in children with intestinal failure.

Methods: This retrospective cohort study assessed glomerular and tubular dysfunction in children receiving parenteral nutrition for intestinal failure at two subsequent time points. Glomerular function was assessed using the estimated glomerular filtration rate and urinary microalbumin/creatinine ratio. Tubular function was assessed using the urinary calcium/creatinine ratio and maximum tubular reabsorption of phosphate for estimated glomerular filtration rate. We tested the association between outcomes and ultrashort bowel, age at admission to the intestinal rehabilitation program, length of follow-up, prematurity, low birth weight, malnutrition, preserved colon in continuity, and ileocecal valve.

Results: The study included 25 patients with a median age of 0.3 (0-14) years, of whom 14 (56%) were boys. Two patients had decreased estimated glomerular filtration rate (one at each time point). Microalbuminuria was observed in four children at time point 1 and persisted in one child at time point 2. Hypercalciuria occurred in 10 of 23 and 9 of 24 children at time points 1 and 2, respectively; 5 maintained this alteration at both time points. Reduced maximum tubular phosphate reabsorption/estimated glomerular filtration rate ratios were observed in 6 of 12 and 2 of 14 children at time points 1 and 2, respectively.

Conclusion: Two-thirds of children with intestinal failure had renal dysfunction, represented by microalbuminuria, reduced estimated glomerular filtration rate, hypercalciuria, and phosphaturia.