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Intestinal failure as a significant risk factor for renal impairment in children

Elisa Ylinen1, Laura Merras-Salmio2, Riikka Gunnar2

  • 1Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.

Nutrition (Burbank, Los Angeles County, Calif.)
|November 14, 2017
PubMed

Insights

Pediatric intestinal failure (IF) patients face significant kidney function decline, particularly with prolonged parenteral nutrition (PN) and shorter remaining small bowel length. Further research is needed to fully understand these risks.

Area of Science:

  • Pediatric Nephrology
  • Gastroenterology
  • Intestinal Failure Management

Background:

  • Impaired renal function is common in adults with intestinal failure (IF), but data in children is limited.
  • Pediatric-onset IF affects children requiring long-term nutritional support.
  • Assessing renal function in this vulnerable population is crucial for early intervention.

Purpose of the Study:

  • To evaluate the prevalence and risk factors of impaired renal function in children with IF.
  • To determine the association between parenteral nutrition (PN) duration and renal function.
  • To investigate the impact of remaining small bowel length on kidney health.

Main Methods:

  • Retrospective analysis of 70 patients with pediatric-onset IF (short bowel syndrome or motility disorder).
  • Assessment of renal function using plasma creatinine, cystatin C, urea, and estimated glomerular filtration rate (eGFR).
  • Evaluation of PN duration and percentage of age-adjusted small bowel length remaining.

Main Results:

  • 29% of patients exhibited decreased eGFR and elevated cystatin C and urea levels.
  • Longer PN duration (3.2 vs 0.9 years) and shorter remaining small bowel length (22% vs 32%) were significantly associated with impaired renal function.
  • No other predisposing factors for decreased eGFR were identified in this cohort.

Conclusions:

  • Pediatric-onset IF poses a significant risk for impaired renal function.
  • The duration of PN and the extent of remaining small bowel are key associated factors.
  • Further investigation with measured GFR is recommended to confirm these findings.
Abstract

Keywords:
Intestinal failureKidneyParenteral nutritionPediatricShort bowel syndrome

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