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Reducing Metabolic Bone Disease Burden in Intestinal Failure Children on Home Parenteral Nutrition
Andreas Tridimas1,2, Raja Padidela3,4, John Bassett1
1From the Directorate of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK.
Insights
Secondary hyperparathyroidism is common in pediatric patients on home parenteral nutrition. An algorithm improved parathyroid hormone (PTH) levels, reducing the risk of metabolic bone disease.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Nutritional Science
Background:
- Secondary hyperparathyroidism is a frequent complication in pediatric patients requiring long-term home parenteral nutrition.
- This condition can lead to significant metabolic bone disease if not adequately managed.
Purpose of the Study:
- To ascertain the prevalence of secondary hyperparathyroidism in pediatric patients receiving home parenteral nutrition.
- To evaluate the effectiveness of a newly developed algorithm in managing parathyroid hormone (PTH) levels.
Main Methods:
- A service review examined a cohort of 37 pediatric intestinal failure patients on home parenteral nutrition over approximately 4 years.
- A follow-up audit was conducted on 33 patients after implementing an algorithm to manage PTH levels.
Main Results:
- Initially, 22 (59%) patients had elevated PTH, with 5 (14%) showing persistently high levels.
- After algorithm implementation, elevated PTH decreased to 6 (18%), and no patients had persistently high levels.
Conclusions:
- Elevated PTH is a common finding in pediatric intestinal failure patients on home parenteral nutrition.
- Optimizing nutritional parameters like calcium-phosphate ratio and vitamin D is crucial.
- An algorithm may assist clinicians in managing PTH and preventing metabolic bone disease.
Objective:
To determine the prevalence of secondary hyperparathyroidism in a cohort of pediatric patients receiving home parenteral nutrition.
Methods:
For a service review, a population-based cohort of 37 pediatric intestinal failure patients receiving long-term parenteral nutrition that underwent serial biochemical monitoring during a study period of approximately 4 years were examined. Following the production of an algorithm, a follow-up audit was carried out (n = 33) after approximately 6 months.
Results:
Of the 37 patients examined in the initial service review, 22 (59%) were found to have an elevated parathyroid hormone (PTH) during the period of monitoring and 5 (14%) had a persistently elevated PTH. In the follow-up audit following the implementation of an algorithm, the number with elevated PTH reduced to 6 (18%) and no patients had persistently high levels.
Conclusion:
Elevated PTH is a common biochemical finding in pediatric intestinal failure patients receiving home parenteral nutrition and its presence should alert clinicians to the need to optimize nutritional parameters such as calcium to phosphate molar ratio and vitamin D status; failure to do so may increase the future burden of metabolic bone disease in such patients. We propose that an algorithm may help in this endeavor.
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