Descriptive Analysis of Renal Function and Potential Renal Acid Load in Adult Patients with Long-term Home Parenteral Nutrition Support: A Retrospective Study
Bibliographic record
Abstract
Background: Home parenteral nutrition (HPN) is an established therapy for chronic intestinal failure (CIF). The relationship between CIF and HPN with renal function and kidney disease has yet to be well described in this population. Our study aims to describe chronic kidney disease (CKD) with renal function and potential acidosis load in patients who received long-term HPN. Methods: We conducted a retrospective study in Edmonton, Alberta. Adult patients aged ≥18 who visited the HPN clinic between Jan 2022 and Mar 2023 were enrolled. The patient admitted to the program for less than six months was excluded. Electronic medical records were reviewed for five years to collect demographic data, the presence of CIF, HPN indications and prescription, the presence of CKD and renal functions. The primary outcome was the estimated glomerular filtration rate (eGFR) with its change after admission to the program and potential total acids load (PTAL). Secondary outcomes included predicted pH, amino acids, glucose, lipid, electrolytes, trace elements, acetate concentration and estimated osmolality load in TPN prescription. Results: Sixty-one adult patients were included in the study. The mean age was 59.20 ± 11.51 years old, 27.9 % were male and short bowel syndrome was noted in 59%; the most common cause of short bowel syndrome was Crohn’s disease. Diabetes mellitus was 16.4 %, Hypertension was 39.3%, and CKD was 47.5%. The most common cause of CKD was nephrolithiasis. The duration of HPN was 6.03 years. An average eGFR was 84.51 ± 27.09 ml/min/1.73 m2 with a mean change of -2.69 ± 3.21 ml/min/1.73 m2/year, and the incident rate of rapid GFR decline was 27.9% in five-year follow-up. The median amount of amino acids was 1.19 (0.85, 1.55) g/kg/day. The average pH of the TPN solution was 5.33 ± 0.36. The median of PTAL was 71.43 (48.35, 95.05) mmol/bag without statistical correlation with CKD when normalised by body weight. Conclusions: The prevalence of CKD in the HPN was higher than in the general population, with a high rate of eGFR decline. The study showed no statistical correlation between PTAL and CKD in those patients. A prospective study with different GFR measurements should be conducted for the accuracy of eGFR and to demonstrate risk factors for the deterioration of renal function. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".