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Determinants and risk factors for renal damage: where do patients hospitalized for severe anorexia nervosa stand? A multi-center study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年6月5日

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  • Chantal Stheneur,
  • Corinne Blanchet,
  • Lama Mattar,
  • Marika Dicembre,
  • Kayigan Wilson,
  • Jeanne Duclos,
  • Hélène Roux,
  • Marie-Raphaële Thiébaud,
  • Sarah Vibert,
  • Tamara Hubert,
  • Annaig Courty,
  • Damien Ringuenet,
  • Jean-Pierre Benoit,
  • Marie-Rose Moro,
  • Laura Bignami,
  • Clémentine Nordon,
  • Frédéric Rouillon,
  • Solange Cook,
  • Catherine Doyen,
  • Marie-Christine Mouren,
  • Priscille Gerardin,
  • Sylvie Lebecq,
  • Marc-Antoine Podlipski,
  • Claire Gayet,
  • Malaika Lasfar,
  • Marc Delorme,
  • Xavier Pommereau,
  • Stéphanie Bioulac,
  • Manuel Bouvard,
  • Jennifer Carrere,
  • Karine Doncieux,
  • Sophie Faucher,
  • Catherine Fayollet,
  • Amélie Prexl,
  • Stéphane Billard,
  • François Lang,
  • Virginie Mourier-Soleillant,
  • Régine Greiner,
  • Aurélia Gay,
  • Guy Carrot,
  • Sylvain Lambert,
  • Morgane Rousselet,
  • Ludovic Placé,
  • Jean-Luc Venisse,
  • Marie Bronnec,
  • Bruno Falissard,
  • Christophe Genolini,
  • Christine Hassler,
  • Jean-Marc Tréluyer,
  • Olivier Chacornac,
  • Maryline Delattre,
  • Nellie Moulopo,
  • Christelle Turuban,
  • Christelle Auger,
  • Sylvie Berthoz,
  • Mouna Hanachi,
  • Nathalie Godart

摘要

Background

Although renal damage is increasingly reported among the most undernourished patients with Anorexia Nervosa (AN), it remains underestimated in current practice, and often associated with acute dehydration. The purpose of our study was to evaluate the frequency, the extent, and the risk factors of renal involvement among adolescents and adults hospitalized in specialized units for AN.

Methods

In this multi-center study, 197 consecutive participants were included, aged 13–65, from 11 inpatient eating disorder psychiatric units. Information on the course of AN, clinical characteristics, biological data, and medication were collected.

Results

At admission, mean BMI was 13.1 (± 1.6) kg/m2 for a mean age of 20.74 (± 6.5) years and the z-score was − 3.6 (± 1.33). Six participants (3.0%) had hyponatremia, four (2.0%) had hypokalemia, and nine (4.5%) had hypochloremia. The Blood Urea Nitrogen/Creatinine ratio was over 20 for 21 (10.6%) participants. The mean plasma creatinine was 65.22 (± 12.8) µmol/L, and the mean eGFR was 74.74 (± 18.9) ml/min. Thirty- five participants (17.8%) had an eGFR > 90 ml/min, 123 (62.4%) from 60 to 90 ml/min, 35 (17.8%) from 45 to 60 ml/min, and 4 (2%) under 45 ml/min. In multivariate analysis, only BMI on admission was a determinant of renal impairment. The lower the BMI the more severe was the renal impairment.

Conclusion

When eGFR is calculated, it highlights renal dysfunction found in severe AN requiring hospitalisation in specialized units. The severity of undernutrition is an independent associated factor. Kidney functionality tests using eGFR, in addition to creatinine alone, should be part of routine care for patients with AN to detect underlying renal dysfunction.