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

Abstract

Although impaired renal function has been a frequent finding among adults with intestinal failure (IF), the data on children is scarce. The aim of this study was to assess renal function in pediatric-onset IF. Medical records of 70 patients (38 boys) with pediatric-onset IF due to either short bowel syndrome (n=59) or primary motility disorder (n=11) and a history of parenteral nutrition (PN) dependency for ≥1mo were evaluated. Renal function at the most recent follow-up was studied using plasma creatinine, cystatin C, and urea concentrations and estimated glomerular filtration rate (eGFR). At a median age of 5.7y and after PN duration of 3.2y, 20 patients (29%) had decreased eGFR and higher cystatin C and urea concentrations. Patients with decreased renal function had significantly longer duration of PN (3.2 versus 0.9y; P=0.030) and shorter percentage of age-adjusted small bowel length remaining (22 versus 32%; P=0.041) compared with patients with preserved renal function. No other predisposing factors for decreased eGFR were identified. Patients with pediatric-onset IF are at significant risk for impaired renal function, which is associated with the duration of PN and the length of the remaining small bowel. In the present study, no other predisposing factors for decreased eGFR were found. Further studies using measured GFR are needed.