Kidney stones are common in patients with short-bowel syndrome receiving long-term parenteral nutrition: A predictive model for urolithiasis.
home parenteral nutrition
hyperoxaluria
kidney stones
nephrolithiasis
short-bowel syndrome
urinary stones
urolithiasis
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
pubmed:
4
5
2021
medline:
1
4
2022
entrez:
3
5
2021
Statut:
ppublish
Résumé
In short-bowel syndrome (SBS) treated with parenteral nutrition (PN), multiple complications can occur. The etiology of kidney stones may be linked to the underlying disease thrombosis, surgical complications, complications of therapy for cancer, Crohn's disease, metabolic abnormalities resulting from morphological and functional changes in the gastrointestinal tract, and to treatment used. We analyzed all these parameters in a large cohort of patients receiving home PN (HPN), to define the incidence of stones and groups of patients particularly at risk of stone formation. One of the objectiveswas to develop a predictive model of urolithiasis. This observational retrospective study included 459 patients with SBS recieving HPN in a single center. Patient records were evaluated for demographics, SBS etiology, and underlying disease, anatomy of the gastrointestinal tract, intestinal failure classification, nutrition regimen, and presence of urolithiasis. Kidney stones were diagnosed in 24% of patients. Nodifferences in incidence were noted between the various etiologic groups. The incidence in patients with a colon in continuity and those with an end stoma was similar. The length of residual small bowel did not play a role in stone formation. There were no differences between patients according to the severity of intestinal failure. In patients treated with PN and limited oral feeding, the risk of urolithiasis was twice as high as in patients receiving PN only. Patients developed urolithiasis with no relation to the SBS etiology. The risk of kidney stone formation was higher in patients recieving PN with oral feeding.
Sections du résumé
BACKGROUND
In short-bowel syndrome (SBS) treated with parenteral nutrition (PN), multiple complications can occur. The etiology of kidney stones may be linked to the underlying disease thrombosis, surgical complications, complications of therapy for cancer, Crohn's disease, metabolic abnormalities resulting from morphological and functional changes in the gastrointestinal tract, and to treatment used. We analyzed all these parameters in a large cohort of patients receiving home PN (HPN), to define the incidence of stones and groups of patients particularly at risk of stone formation. One of the objectiveswas to develop a predictive model of urolithiasis.
METHODS
This observational retrospective study included 459 patients with SBS recieving HPN in a single center. Patient records were evaluated for demographics, SBS etiology, and underlying disease, anatomy of the gastrointestinal tract, intestinal failure classification, nutrition regimen, and presence of urolithiasis.
RESULTS
Kidney stones were diagnosed in 24% of patients. Nodifferences in incidence were noted between the various etiologic groups. The incidence in patients with a colon in continuity and those with an end stoma was similar. The length of residual small bowel did not play a role in stone formation. There were no differences between patients according to the severity of intestinal failure. In patients treated with PN and limited oral feeding, the risk of urolithiasis was twice as high as in patients receiving PN only.
CONCLUSIONS
Patients developed urolithiasis with no relation to the SBS etiology. The risk of kidney stone formation was higher in patients recieving PN with oral feeding.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
671-677Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 American Society for Parenteral and Enteral Nutrition.
Références
Pironi L, Konrad D, Brandt C, et al. Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey. Clin Nutr. 2018;37(2):728-738.
Pironi L, Arends J, Baxter J, Bozzetti F., Peláez R. B., Cuerda C., et al., Home artificial nutrition & chronic intestinal failure, acute intestinal failure special interest groups of ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults Clin Nutr. 2015;34:171-180.
Staun M, Pironi L, Bozzetti F, et al. ESPEN. ESPEN guidelines on parenteral nutrition: home parenteral nutrition (HPN) in adult patients. Clin Nutr. 2009;28(4):467-479.
Nightingale J, Woodward JM; Small bowel and Nutrition Committee of the British Society of Gastroenterology. Guidelines for management of patients with a short bowel. Gut. 2006;55(Suppl 4):iv1-iv12.
Worcester EM. Stones from bowel disease. Endocrinol Metab Clin North Am. 2002;31(4):979-999.
Hoppe B, Leumann E, von Unruh G, Laube N, Hesse A. Diagnostic and therapeutic approaches in patients with secondary hyperoxaluria. Front Biosci. 2003;8(5):e437-e443.
Ceulemans LJ, Nijs Y, Nuytens F, et al. Combined kidney and intestinal transplantation in patients with enteric hyperoxaluria secondary to short bowel syndrome. Am J Transplant. 2013;13(7):1910-1914.
Rodgers AL, Allie-Hamdulay S, Jackson GE, Sutton RA. Enteric hyperoxaluria secondary to small bowel resection: use of computer simulation to characterize urinary risk factors for stone formation and assess potential treatment protocols. J Endourol. 2014;28(8):985-994.
Nightingale JM. Hepatobiliary, renal and bone complications of intestinal failure. Best Pract Res Clin Gastroenterol. 2003;17(6):907-929.
Nightingale JM, Lennard-Jones JE, Gertner DJ, Wood SR, Bartram CI. Colonic preservation reduces need for parenteral therapy, increases incidence of renal stones, but does not change high prevalence of gall stones in patients with a short bowel. Gut. 1992;33(11):1493-1497.
Van Gossum A, Vahedi K, Abdel-Malik SM, et al. ESPEN-HAN Working Group. Clinical, social and rehabilitation status of long-term home parenteral nutrition patients: results of a European multicentre survey. Clin Nutr. 2001;20(3):205-210.
Pironi L, Labate AM, Pertkiewicz M, et al. Espen-Home Artificial Nutrition Working Group. Prevalence of bone disease in patients on home parenteral nutrition. Clin Nutr. 2002;21(4):289-296.
Raman M, Aghdassi E, Baun M, et al. Metabolic bone disease in patients receiving home parenteral nutrition: a Canadian Study and Review. JPEN J Parenter Enteral Nutr. 2006;30(6):492-496.
Cohen-Solal M, Baudoin C, Joly F, et al. Osteoporosis in patients on long-term home parenteral nutrition: a Longitudinal Study. J Bone Miner Res. 2003;18(11):1989-1994.
Türk C, Knoll T, Petrik A, et al. Guidelines on 382 Urolithiasis. Europe: European Association of Urology; 2014.
Pearle MS, Goldfarb DS, Assimos DG, et al. American Urological Assocation. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316-324.
Thompson JS, DiBaise JK, Iyer KR, Yeats M, Sudan DL. Postoperative short bowel syndrome. J Am Coll Surg. 2005;201(1):85-89.
Thompson JS, Iyer KR, DiBaise JK, Young RL, Brown CR, Langnas AN. Short bowel syndrome and Crohn's disease. J Gastrointest Surg. 2003;7(8):1069-1072.
Dreesen M, Foulon V, Vanhaecht K, De Pourcq L, Hiele M, Willems L. Guidelines recommendations on care of adult patients receiving home parenteral nutrition: a systematic review of global practices. Clin Nutr. 2012;31(5):602-608.
Nightingale JM, Lennard-Jones JE. The short bowel syndrome: what's new and old? Dig Dis. 1993;11(1):12-31.
Dobbins JW, Binder HJ. Importance of the colon in enteric hyperoxaluria. N Engl J Med. 1977;296(6):298-301.
Earnest DL, Johnson G, Williams HE, Admirand WH. Hyperoxaluria in patients with ileal resection: an abnormality in dietary oxalate absorption. Gastroenterology. 1974;66(6):1114-1122.
Ogawa Y, Yonou H, Hokama S, Oda M, Morozumi M, Sugaya K. Urinary saturation and risk factors for calcium oxalate stone disease based on spot and 24-hour urine specimens. Front Biosci. 2003;8(1):a167-a176.
Maj-Żurawska M, Drygieniec D, Pertkiewicz M: Significance of ionised magnesium disturbances in short bowel. Clin Nutr. 1994;13(Supplement 1):54.
Fink HA, Akornor JW, Garimella PS, et al. Diet, fluid, or supplements for secondary prevention of nephrolithiasis: a systematic review and meta-analysis of randomized trials. Eur Urol. 2009;56(1):72-80.
Rudman D, Dedonis JL, Fountain MT, et al. Hypocitraturia in patients with gastrointestinal malabsorption. N Engl J Med. 1980;303(12):657-661.
Chadwick VS, Modha K, Dowling RH. Mechanism for hyperoxaluria in patients with ileal dysfunction. N Engl J Med. 1973;289(4):172-176.
Stauffer JQ, Humphreys MH, Weir GJ. Acquired hyperoxaluria with regional enteritis after ileal resection. Role of dietary oxalate. Ann Intern Med. 1973;79(3):383-391.