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Acute pancreatitis in children on chronic maintenance dialysis
Enrico Vidal1, Irene Alberici2, Enrico Verrina3
1Pediatric Nephrology, Dialysis and Transplant Unit, Department for Woman's and Child's Health, University-Hospital of Padova, Via Giustiniani 3, 35128, Padova, Italy. enrico.vidal@inwind.it.
Insights
Children on chronic dialysis face a significantly higher risk of acute pancreatitis (AP) compared to the general pediatric population. Diagnosis and management require careful consideration due to confounding factors and potential complications in this vulnerable group.
Area of Science:
- Nephrology
- Pediatric Gastroenterology
- Critical Care Medicine
Background:
- Patients undergoing dialysis are susceptible to acute pancreatitis (AP) due to factors like medications, hyperparathyroidism, hypercalcemia, and hypertriglyceridemia.
- The specific role of dialysis modality in AP risk remains under investigation.
- Limited data exist on AP incidence and outcomes in pediatric patients on chronic dialysis.
Purpose of the Study:
- To investigate the risk of AP in children undergoing chronic dialysis.
- To analyze the diagnostic challenges and management strategies for AP in this population.
- To report on the outcomes and mortality associated with AP in pediatric dialysis patients.
Main Methods:
- Utilized data from the Italian Registry of Pediatric Chronic Dialysis (IRPCD).
- Compared AP relative risk (RR) in pediatric dialysis patients to the general pediatric population.
- Reviewed diagnostic approaches, including instrumental imaging, and management strategies for AP.
- Analyzed mortality data for pediatric patients with AP on chronic dialysis.
Main Results:
- Children on chronic dialysis exhibit a significantly increased relative risk (RR) of 60.4 for AP compared to the general pediatric population.
- Diagnosis of AP in dialysis patients is challenging, often mimicking other abdominal conditions, necessitating instrumental imaging.
- The study series of 12 pediatric patients on chronic dialysis reported a 25% mortality rate, though deaths were not directly attributed to AP.
- Adult case series indicate variable mortality (8-58%) for AP in dialysis patients, higher than the 10% mortality in non-renal failure patients.
Conclusions:
- Pediatric patients on chronic dialysis have a substantially elevated risk of acute pancreatitis.
- Accurate diagnosis of AP in dialysis patients requires advanced imaging due to confounding clinical presentations.
- While conservative management is typical, AP in dialysis patients, particularly adults, carries a higher mortality risk compared to the general population.
Abstract:
Patients on dialysis are exposed to a series of factors that are known to be associated with risk of acute pancreatitis (AP), including medications, hyperparathyroidism, hypercalcemia, and hypertriglyceridemia; the role of the dialysis modality itself is still debated. Data regarding AP in children on chronic dialysis are scarce. Data from the Italian Registry of Pediatric Chronic Dialysis (IRPCD) confirm that children on dialysis have a significant increased relative risk (RR) for AP as compared with the general pediatric population (RR 60.4; 95% CI 3.2-214). Diagnosis of AP in patients on dialysis may be troublesome, because it can mimic other acute intraabdominal conditions and the role of serum pancreatic enzyme assays may be confounding. In this setting, instrumental imaging is mandatory. Conservative management such as fluid, bowel rest, and antibiotics is the mainstay of AP management, as necrotizing forms are rare. Mortality in the series of 12 patients from the IRPCD was high (25%), but deaths were not directly related to AP. Adult case series confirm that mortality among patients on dialysis who develop AP is highly variable (8-58%), but higher as compared to 10% mortality from AP in non-renal failure patients.
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