Risk Factors for Renal Impairment in Adult Patients With Short Bowel Syndrome.

Peng Wang,Xinying Wang,Yupeng Zhang,Xuejin Gao,Jianbo Yang,Li Zhang

doi:10.3389/fnut.2020.618758

Abstract

Renal impairment is a common complication in patients with intestinal failure that is mostly caused by short bowel syndrome (SBS) and is associated with adverse outcomes that severely affect the quality of life or even survival. The prevalence and risk factors for renal impairment in patients with SBS remain unclarified. Therefore, we aimed to determine the prevalence of renal impairment and identify potential risk factors for renal impairment in adult patients with SBS. We retrospectively identified 199 patients diagnosed with SBS admitted to the Department of General Surgery between January 1, 2012 and January 1, 2019, from a prospectively maintained database. Overall, 56 patients (28.1%) with decreased renal function (eGFR < 90 mL/min/1.73 m2). The median duration of SBS was 7 months (IQR, 3–31 months) and the mean eGFR was 103.1 ± 39.4 mL/min/1.73 m2. Logistic regression modeling indicated that older age [odds ratio (OR), 1.074; 95% CI, 1.037–1.112, P < 0.001], kidney stones (OR, 4.887; 95% CI, 1.753–13.626; P = 0.002), decreased length of the small intestine (OR, 0.988; 95% CI, 0.979–0.998; P = 0.019), and prolonged duration of SBS (OR, 1.007; 95% CI, 1.001–1.013; P = 0.046) were significant risk factors for renal impairment. This is the largest study that has specifically explored the risk factors for renal impairment in a large cohort of adults with SBS. The present study showed that renal function should be closely monitored during treatment, and patients should be given prophylactic interventions if necessary. This retrospective study is a part of clinical study NCT03277014, registered in ClinicalTrials.gov PRS. And the PRS URL is http://register.clinicaltrials.gov.

Highlights

Short bowel syndrome (SBS) is a rare disease usually caused by the removal of the small intestine due to a variety of underlying diseases, and it accounts for 74.4% of chronic intestinal failure [1]
According to our exclusion criteria, data from 40 patients were not used in the present study because they were either in the acute stage of the SBS (20 patients) or estimated GFR (eGFR) < 90 mL/min/1.73 m2 before SBS diagnosed (6 patients) or age
The results indicated that the age (P < 0.001), SBS duration (P = 0.046), small bowel length (P = 0.019), and existing kidney stones (P = 0.002) were independent risk factors for reduced eGFR

Summary

Introduction

Short bowel syndrome (SBS) is a rare disease usually caused by the removal of the small intestine due to a variety of underlying diseases, and it accounts for 74.4% of chronic intestinal failure [1]. In patients with intestinal failure who are treated with long-term parenteral nutrition (PN) support therapy, impaired kidney function has been reported [2,3,4,5]. Worldwide, increasing numbers of patients are affected by chronic kidney disease [6,7,8]. Two factors that have been reported are important for end-stage renal disease (ESRD): aging and type 2 diabetes mellitus [8]. The gold standard for evaluating renal function involves inulin or radiolabeled markers to measure the glomerular filtration rate (GFR) [9, 10]. Considering the cost and complexities of measuring GFR, estimated GFR (eGFR) is widely used in clinical work

Objectives

Methods

Results

Discussion

Conclusion