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

Ylinen, Elisa; Merras‐Salmio, Laura; Gunnar, Riikka; Jahnukainen, Timo; Pakarinen, Mikko P.

doi:10.1016/j.nut.2017.07.011

Cited by 19 publications

(25 citation statements)

References 21 publications

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“…Intestinal insufficiency is a term that describes the special need population of former patients with IF having reached full enteral nutrition (EN) by intestinal adaptation and compensative increase in enteral intake, with or without the help of pharmacological agents . Patients with intestinal insufficiency still experience significant gastrointestinal symptoms and may be at risk for malnutrition and dehydration, and as our group has shown, renal impairment and liver injury as well …”

Section: Introductionmentioning

confidence: 98%

“…13,14 Patients with intestinal insufficiency still experience significant gastrointestinal symptoms and may be at risk for malnutrition and dehydration, and as our group has shown, renal impairment and liver injury as well. 15,16 The non-SBS causes for pediatric IF include primary intestinal motility disorders (PIMDs) and various congenital intestinopathies. The likelihood of weaning off PN remains lower in these patient groups, necessitating expert longterm care to ensure adequate nutrition, while minimizing liver derangements and central venous catheter (CVC)associated hazards.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Intestinal Failure: The Key Outcomes for the First 100 Patients Treated in a National Tertiary Referral Center During 1984–2017

Merras‐Salmio

Mutanen

Ylinen

et al. 2018

J Parenter Enteral Nutr

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Pediatric Intestinal Failure: The Key Outcomes for the First 100 Patients Treated in a National Tertiary Referral Center During 1984–2017

Merras‐Salmio

Mutanen

Ylinen

et al. 2018

J Parenter Enteral Nutr

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“…IF‐associated renal disease is often an unrecognized complication of long‐term PN therapy. Renal impairment has been reported to occur in 30–56% of long‐term PN patients using an estimated glomerular filtration rate (GFR) . However, the estimated GFR underappreciates true renal function as creatinine is a poor marker of renal function, especially in the early stages of renal damage, even more in presence of low lean body mass.…”

Section: Monitoring Of Long‐term Complicationsmentioning

confidence: 99%

“…However, the estimated GFR underappreciates true renal function as creatinine is a poor marker of renal function, especially in the early stages of renal damage, even more in presence of low lean body mass. Cystatin C is not related to muscle mass and may be a better indicator of renal function . The measured GFR is the gold standard to assess renal function but is complex in practice .…”

Section: Monitoring Of Long‐term Complicationsmentioning

confidence: 99%

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Monitoring of long‐term parenteral nutrition in children with intestinal failure

Zemrani

Bines

2019

JGH Open

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Pediatric intestinal failure (IF) is a rare and complex condition associated with significant morbidity and mortality. It is defined as the reduction of gut mass or function below the minimal needed for absorption of nutrients and fluid to sustain life and growth. Since the advent of specialized multidisciplinary intestinal rehabilitation centers, IF management has considerably evolved in the last years, but serious complications of long‐term parenteral nutrition (PN) can occur. Main complications include intestinal failure‐associated liver disease, growth failure, body composition imbalance, central venous access complications, micronutrient deficiencies and toxicities, metabolic bone disease, small intestinal bacterial overgrowth, and renal disease. With improvement in survival rates of patients over the last 20 years, emphasis should be on limiting IF‐related comorbidities and improving quality of life. Close monitoring is pivotal to ensuring quality of care of these patients. The care of children with chronic IF should involve a comprehensive monitoring plan with flexibility for individualization according to specific patient needs. Monitoring of children on long‐term PN varies significantly across units and is mainly based on experience, although few guidelines exist. This narrative review summarizes the current knowledge and practices related to monitoring of children with IF. The authors also share their 20‐year experience at the Royal Children's Hospital in Melbourne Australia on this topic.

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Pharmacokinetics and Tolerability of a Single Dose of Apraglutide, a Novel, Long‐Acting, Synthetic glucagon‐like peptide‐2 Analog With a Unique Pharmacologic Profile, in Individuals With Impaired Renal Function

Greig,

Youssef,

Bolognani

2024

The Journal of Clinical Pharma

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Renal impairment is a common complication in patients with short bowel syndrome with intestinal failure (SBS‐IF). Glucagon‐like peptide‐2 analogs, such as apraglutide, have been developed as a treatment option for SBS‐IF. This study assessed the potential for apraglutide overexposure in individuals with severely impaired renal function versus healthy volunteers with normal renal function. In this phase 1, open‐label, multicenter, nonrandomized, parallel‐group study, a single dose of apraglutide 5 mg was administered subcutaneously to individuals with severely impaired renal function (<30 mL/min/1.73 m2) and healthy volunteers with normal renal function (≥90 mL/min/1.73 m2). Primary pharmacokinetic endpoints were maximum observed concentration (Cmax) and exposure to apraglutide (area under the curve [AUC] from time 0 to infinity [AUCinf], and AUC from time 0 to the last quantifiable concentration [AUClast]). Each group comprised 8 individuals. Results show that patients with severe renal impairment do not have increased apraglutide exposure. Apraglutide achieved a lower Cmax and AUCinf in individuals with severe renal impairment versus those with normal renal function (Cmax = 36.9 vs 59.5 ng/L; AUCinf = 3100 vs 4470 h · ng/mL, respectively). The respective geometric mean ratios were 0.620 and 0.693 for Cmax and AUCinf, and the upper bound of their 90% confidence intervals were <2, indicating patients with severe renal impairment were not overexposed to apraglutide versus those with normal renal function. Adverse events were mild or moderate in severity. Apraglutide does not require dose reduction for any degree of renal impairment and could be used in a broader patient population of renally impaired patients without dose adjustment.

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

Cited by 19 publications

References 21 publications

Pediatric Intestinal Failure: The Key Outcomes for the First 100 Patients Treated in a National Tertiary Referral Center During 1984–2017

Pediatric Intestinal Failure: The Key Outcomes for the First 100 Patients Treated in a National Tertiary Referral Center During 1984–2017

Monitoring of long‐term parenteral nutrition in children with intestinal failure

Pharmacokinetics and Tolerability of a Single Dose of Apraglutide, a Novel, Long‐Acting, Synthetic glucagon‐like peptide‐2 Analog With a Unique Pharmacologic Profile, in Individuals With Impaired Renal Function

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