title: Renal function in patients on long-term home parenteral nutrition and in intestinal transplant recipients.
abstract: OBJECTIVE
  A decrease of renal function was described in patients on long-term home parenteral nutrition (HPN) for benign intestinal failure. The risk for chronic renal failure (CRF) due to frequent episodes of dehydration despite optimal HPN, is an indication for intestinal transplantation (ITx). ITx is the solid organ transplant at highest risk for developing CRF. The aim of this study was to compare the prevalence and the probability of CRF occurring in adults on HPN and after ITx.
  
  
  METHODS
  A cross-sectional and retrospective follow-up study was carried out in 2011. Renal function was evaluated at cross-sectional and at time of starting HPN or ITx, by serum creatinine concentration (mg/dL) and estimated glomerular filtration rate (eGFR), according to the Modification of Diet in Renal Disease equation (mL·min·1.73 m2). CRF was defined as eGFR <60. Duration of follow up was from time of starting treatment to time of cross-sectional.
  
  
  RESULTS
  We enrolled 33 patients on HPN and 22 who had undergone ITx. The frequency of CRF was 6% in the HPN group and 9% in the ITx group (P = 0.67) at start of treatment, and 21% and 54%, respectively (P = 0.01) at the time of the cross-sectional evaluation. During the follow-up, the annual decline of eGFR was 2.8% and 14.5%, respectively (P = 0.02). The 5-y probability of maintaining an eGFR ≥60 was 84% in the HPN group and 44% in the ITx group (P < 0.001).
  
  
  CONCLUSIONS
  The decrease of renal function and the risk for developing CRF are greater after ITx than during HPN. The risk for CRF on HPN, as a criterion for ITx, should be revised.
authors: Center for Chronic Intestinal Failure, University of Bologna, Bologna, Italy. Electronic address: Loris.pironi@unibo.it.
authors: Loris
authors: L
authors: Pironi
authors: Transplantation Unit, University of Bologna, Bologna, Italy.
authors: Augusto
authors: A
authors: Lauro
authors: Center for Chronic Intestinal Failure, University of Bologna, Bologna, Italy.
authors: Valentina
authors: V
authors: Soverini
authors: Transplantation Unit, University of Bologna, Bologna, Italy.
authors: Chiara
authors: C
authors: Zanfi
authors: Center for Chronic Intestinal Failure, University of Bologna, Bologna, Italy.
authors: Federica
authors: F
authors: Agostini
authors: Center for Chronic Intestinal Failure, University of Bologna, Bologna, Italy.
authors: Mariacristina
authors: M
authors: Guidetti
authors: Center for Chronic Intestinal Failure, University of Bologna, Bologna, Italy.
authors: Caterina
authors: C
authors: Pazzeschi
authors: Transplantation Unit, University of Bologna, Bologna, Italy.
authors: Antonio Daniele
authors: AD
authors: Pinna
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003681:Dehydration / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery / Q000628:therapy; D007422:Intestines / Q000637:transplantation*; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015995:Prevalence; D011336:Probability; D012189:Retrospective Studies; D066027:Transplant Recipients; D055815:Young Adult
keywords: Chronic renal failure; Home parenteral nutrition; Intestinal failure; Intestinal transplant