Frequency and severity of acute pancreatitis in chronic dialysis patients

Abstract

The incidence and severity of acute pancreatitis in patients undergoing dialysis treatment are unknown. A questionnaire asking for the incidence and the severity of a first attack of acute pancreatitis in chronic dialysis patients in the year 2002 was sent to the members of QuaSi-Niere gGmbH, an organization representing almost all dialysis centres in Germany. A second questionnaire was sent to those who reported such patients. Response rates for the first and second questionnaire were 72% (832 out of 1150 centres) and 100% (72 out of 72 centres), respectively. After the exclusion of patients with invalid data, 55 patients with acute pancreatitis remained: 46 patients out of 68 715 haemodialysis (HD) patients (incidence rate 67/100 000/year; 95% confidence interval, 49 to 89/100 000/year) and 9 out of 3386 peritoneal dialysis (PD) patients (incidence rate 266/100 000/year; 95% confidence interval, 122 to 504/100 000/year; Fisher's exact test: P = 0.002). Twenty-eight patients (51%) had a known risk factor for acute pancreatitis. When these were excluded, the incidence of pancreatitis of unknown aetiology was 32/100 000/year (20-48) for HD patients (n, 22) and 148/100 000/year (48-345) for PD patients (n, 3; Fisher's exact test: P = 0.016). PD patients required hospital admission more frequently than HD patients (100% versus 76%) and suffered more frequently from necrotizing pancreatitis (50% versus 19%). Dialysis-especially PD-is another risk factor that increases the susceptibility of the pancreas to acute pancreatitis. Acute pancreatitis in patients undergoing PD is more frequent and seems to be more severe than in those receiving HD treatment.