Chen HJ, et al. - This study focused on acute pancreatitis (AP) in end-stage renal disease (ESRD) managed with dialysis and assessed not only the incidence and severity of AP in such patients but also the impact of dialysis modality [hemodialysis (HD) versus peritoneal dialysis (PD)] on risk for AP as well as complications or mortality associated with AP. Findings revealed that PD versus HD conferred a higher risk for AP. Furthermore, upper gastrointestinal (UGI) bleeding was more reported in HD patients with AP attacks and a more frequent need for total parenteral nutrition (TPN) support was realized in PD patients with AP attacks.

Methods

• Researchers analyzed national health insurance claims data of 67 078 ESRD Taiwanese patients initiating dialysis between 1999 and 2007.
• All patients were followed up from the start of their dialysis to first AP diagnosis, death, end of dialysis or 31 December 2008.
• Risk factors were determined using Cox proportional hazards models.

Results

• Data reported that the cumulative incidence rates of AP were 0.6, 1.7, 2.6, 3.4 and 4% at 1, 3, 5, 7 and 9 years, respectively.
• Findings also demonstrated that ESRD patients on HD and PD had an AP incidence of 5.11 and 5.86 per 1000 person-years, respectively.
• Being elderly, being female, having biliary stones or liver disease, and being on PD were identified as the Independent risk factors for AP in this population.
• Additionally, a severe AP occurrence was reported in 44.9% of the HD patients and in 36% of the PD patients.
• Researchers observed a higher incidence of upper gastrointestinal (UGI) bleeding in patients with AP on HD versus on PD (P = 0.002).
• In contrast, it was noted that those with AP on PD had a higher incidence of need for total parenteral nutrition (TPN) support than those on HD (P = 0.072).
• 8.1% was reported as the overall in-hospital mortality.
• Male gender, increased age, AP severity, and the presence of diabetes mellitus or liver disease were identified as the risk factors for mortality after an AP attack.