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Background: Progressive renal impairment, given by an annual decline in estimated glomerular filtration rate (eGFR), has been described in patients with intestinal failure (IF) receiving home parenteral support (HPS). The objective of this study was to examine changes in eGFR over 5 years following initiation of HPS treatment and to identify potential risk factors for loss of renal function. Method: This retrospective database study investigates eGFR changes in nonmalignant IF patients discharged with HPS from Rigshospitalet, Copenhagen, in an 8‐year period. Results: One year after HPS initiation, mean eGFR decreased by 15.3 ml/min/1.73 m2. Paired t‐test showed a decline of 15.0 ml/min/1.73 m2 (95% CI, −18.3 to −11.6; P <.0001). Over the following years, eGFR continued to decrease but at insignificant lower rates. Decreased eGFR was associated with increasing age, female sex, increasing body weight, diabetes at HPS initiation, and a high requirement of HPS volume. Conclusion: In nonmalignant IF patients, the decrease of eGFR was mainly seen during the first year of HPS. This may be due to a higher risk of dehydration and possibly secondary hyperaldosteronism leading to renal damage following the onset of IF. However, the decrease in eGFR may also represent a higher production of creatinine due to a beneficial increase of muscle mass in the initial recovery phase. In general, once the patients were stabilized, the eGFR decline followed a physiological course resembling the background population. Patients with diabetes or high HPS volume needs seem to be more vulnerable and may require special attention. [ABSTRACT FROM AUTHOR]

Background: Impaired renal function is of major concern in human immunodeficiency virus (HIV)-infected patients. Methods: We used a mixed effects linear regression model to determine estimated glomerular filtration rates (eGFRs) in a population-based cohort of incident Danish HIV patients and stratified on baseline eGFR (eGFRB) < 90 and ≥ 90 ml/min per 1.73 m2. Incidence rate ratios (IRRs) for chronic kidney disease (CKD) - 2 consecutive eGFR values < 60 ml/min per 1.73 m2 measured > 3 months apart - were estimated (time-updated Cox-regression model). Results: The effect of time with HIV on eGFR was small in both strata (− 0.09 (95% confidence interval (CI) − 0.27, 0.09) and − 0.46 (95% CI − 0.64, − 0.27) ml/min per 1.73 m2 per y). Treatment with tenofovir and indinavir was associated with lower eGFR in both strata: tenofovir − 2.00 (95% CI − 3.45, − 0.56) and − 1.94 (95% CI − 3.43, − 0.44) ml/min per 1.73 m2 and indinavir − 2.14 (95% CI − 3.63, − 0.64) and − 3.29 (95% CI − 5.25, − 1.32) ml/min per 1.73 m2. Nevirapine, atazanavir, and the combination of tenofovir and atazanavir were associated with lower eGFR in patients with eGFRB < 90 ml/min per 1.73 m2. Highly active antiretroviral therapy (HAART) and exposure to tenofovir and atazanavir in combination were associated with CKD in patients with eGFRB < 90 ml/min per 1.73 m2 (adjusted IRRs 6.08 (95% CI 2.76-13.41) and 26.75 (95% CI 9.54-75.05)). Conclusion: Tenofovir and indinavir reduce eGFR, while time with HIV only has a modest effect on this parameter. Low eGFRB is associated with an increased risk of CKD, especially when receiving HAART regimens containing the combination tenofovir/atazanavir. [ABSTRACT FROM AUTHOR]