Pironi Loris, Lauro Augusto, Soverini Valentina, Zanfi Chiara, Agostini Federica, Guidetti Mariacristina, Pazzeschi Caterina, Pinna Antonio Daniele
Center for Chronic Intestinal Failure, University of Bologna, Bologna, Italy.
Transplantation Unit, University of Bologna, Bologna, Italy.
Nutrition. 2014 Sep;30(9):1011-4. doi: 10.1016/j.nut.2014.02.001. Epub 2014 Feb 20.
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.
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.
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).
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.
有研究描述了因良性肠衰竭接受长期家庭肠外营养（HPN）的患者肾功能会下降。尽管进行了优化的HPN，但因频繁脱水导致慢性肾衰竭（CRF）的风险是进行肠移植（ITx）的指征。ITx是发生CRF风险最高的实体器官移植。本研究的目的是比较接受HPN的成年人和接受ITx后的成年人中CRF的患病率及发生概率。
2011年开展了一项横断面及回顾性随访研究。在横断面研究时以及开始HPN或ITx时，根据肾病饮食改良方程（mL·min·1.73 m²），通过血清肌酐浓度（mg/dL）和估算肾小球滤过率（eGFR）评估肾功能。CRF定义为eGFR＜60。随访时间从开始治疗至横断面研究时间。
我们纳入了33例接受HPN的患者和22例接受ITx的患者。治疗开始时，HPN组CRF的发生率为6%，ITx组为9%（P = 0.67）；在横断面评估时，分别为21%和54%（P = 0.01）。随访期间，eGFR的年下降率分别为2.8%和14.5%（P = 0.02）。HPN组维持eGFR≥60的5年概率为84%，ITx组为44%（P＜0.001）。
ITx后肾功能下降及发生CRF的风险高于HPN期间。作为ITx标准的HPN时CRF风险应重新评估。
