Exocrine pancreatic function in patients with end-stage renal disease

Area of Science:

• Nephrology
• Gastroenterology
• Internal Medicine

Background:

• Malnutrition is prevalent in end-stage renal disease (ESRD) patients.
• Previous studies indicated high rates of exocrine pancreatic insufficiency (EPI) in ESRD patients over 30 years ago.
• The link between EPI, pancreatic morphology, steatorrhea, and the need for enzyme substitution in ESRD remained unclear.

Purpose of the Study:

• To determine the frequency and severity of exocrine pancreatic insufficiency in hemodialysis patients.
• To investigate potential correlations between EPI and patient characteristics or symptoms.
• To assess the prevalence of steatorrhea and diarrhea in this population.

Main Methods:

• Fifty hemodialysis patients without prior pancreatitis or unexplained abdominal symptoms were enrolled.
• Exclusion criteria included hyperthyroidism, history of gastrectomy or bowel resection, and inflammatory bowel disease.
• Fecal elastase-1 levels (using two methods), fecal fat content, and fecal weight were measured in all participants.

Main Results:

• Mild to moderate EPI (elastase-1 100-200 microg/g) was observed in 10% of patients.
• EPI severity did not correlate with age, sex, renal disease type, dialysis duration, diarrhea, or steatorrhea.
• No patient exhibited severe EPI (<100 microg/g stool), indicating no need for enzyme substitution based on this criterion.
• Mild diarrhea (18%) and mild steatorrhea (20%) were noted, with five patients experiencing both.

Conclusions:

• Mild to moderate EPI is not uncommon in hemodialysis patients but is unlikely to be the primary cause of malnutrition in ESRD.
• Non-pancreatic causes of steatorrhea are also prevalent in this group.
• The presence of steatorrhea, regardless of pancreatic origin, may significantly impact nutrition and warrants further research for potential therapeutic strategies.