Teduglutide use in haemodialysis-dependent renal failure from secondary hyperoxaluria in short bowel syndrome and type 3 intestinal failure – A case report

Background: Renal impairment is common in patients receiving long-term home parenteral nutrition (HPN) for short bowel syndrome-associated intestinal failure (SBS-IF). While glucagon-like peptide-2 (GLP-2) analogues like teduglutide are effective in reducing parenteral support (PS) requirements, data on their use in advanced stage chronic kidney disease (CKD) or haemodialysis are scarce. Case report: We describe a 66-year-old female with SBS-IF on HPN, complicated by hyperoxaluria and nephrocalcinosis contributing to stage 4 CKD. Initial renally-adjusted teduglutide dosing (0.025 mg/kg/day) enabled enteral autonomy, but was interrupted by intercurrent illness. As a result of progressive renal dysfunction, the patient was commenced on haemodialysis. Teduglutide was introduced post-dialysis at full dose (0.05 mg/kg), resulting in a sustained 36 % reduction in weekly PS requirements without adverse effects, despite recurrent sepsis. Conclusion: This case demonstrates a clinically significant teduglutide response in a haemodialysis-dependent SBS-IF patient, supporting post-dialysis dosing as a feasible strategy in this HPN cohort.