The risk of acute pancreatitis (AP) is increased in patients with end-stage renal disease (ESRD). To our knowledge, this hypothesis has never been explored in children. In this study we evaluated incidence, clinical characteristics and outcome of AP in a pediatric chronic dialysis population.
AP cases were identified by reviewing files of all patients starting dialysis at <18yrs of age recorded from January 2000 to December 2014 in a nationwide registry.
133 and 237 eligible patients were identified in the peritoneal dialysis (PD) and hemodialysis (HD) groups, respectively. 12 had AP, 7 were treated with HD and 5 with PD. The incidence rate of first-time AP was 9.5 per 1000 person-years for the overall cohort, 6.2/1000 pers./yrs for PD and 15.4/1000 pers./yrs for HD (p=0.04, Fisher’s test). The median age at AP diagnosis was 10 yrs (range 3-16) and median time on dialysis was 11 months (0.5-68). In 7 patients (58%) ESRD was caused by renal dysplasia and 6 patients (50%) were affected by motor-cognitive abnormalities. All patients were hospitalized for a median time of 25 days (2-180). Median peak serum amylase and lipase was 1125 UI/L (234-3431) and 2885 UI/L (612-8140), respectively. Instrumental diagnostic features at presentation included enlarged pancreas (80%) and peripancreatic fluid collections (33%). In 1 case, AP was diagnosed after abdominal surgery with exposure to propofol. At diagnosis, 4 patients were receiving valproic acid and 2 patients enalapril. In 3 cases, AP course was complicated by a pancreatic pseudocyst. One child required a shift from PD to HD because of abdominal pain. Two patients experienced recurrent AP, while there were no deaths related to AP.
Children on dialysis show a significantly increased risk for AP compared with the general pediatric population. A higher incidence is observed in children on HD and in those with co-morbidities.
