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BRUNO MEMOLI - Young Investigator Award (YIA)

Acute pancreatitis in children on chronic dialysis: incidence and clinical characteristic in a nationwide registry

poster

Background

Published literature suggests that the risk of acute pancreatitis (AP) is increased in patients with end-stage renal disease (ESRD) on dialysis [Lee YC - 2015 [1] (full text)]. To our knowledge, this hypothesis has never been explored in the pediatric population. In this study we evaluated incidence, clinical characteristics and outcome of AP in a large population of children receiving chronic dialysis.

Methods

AP cases were identified retrospectively by reviewing files of all patients starting dialysis at <16 years of age recorded from January 2000 to December 2014 in a large nationwide registry.

Results

413 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 (Figura 1). The incidence rate of first-time AP was 9.5 per 1000 person-years for the overall cohort of children in dialysis, 6.2/1000 person/years for PD and 15.4/1000 person/years for HD (p=0.04, Fisher’s test). The median age of AP cases at diagnosis was 10 years (range 3-16), after a median time spent on dialysis of 11 months (0.5-68). In 7 patients (58%) diagnosis leading to ESRD was 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 was 1125 UI/L (234-3431) and median peak lipase was 2885 UI/L (612-8140). Instrumental diagnostic features at presentation included pancreatic heterogeneity with edema (80%) and peripancreatic fluid collections (33%). At AP onset, 1 child was affected by a Rotavirus gastroenteritis. In 1 case AP was diagnosed shortly after an abdominal surgery with exposure to propofol. At AP diagnosis, 4 patients were receiving valproic acid and 2 patients enalapril. All patients were treated with antibiotics and analgesics, 80% required total parenteral nutrition and 22% received glabexate mesilate. In 3 cases the AP course was complicated with a pancreatic pseudocyst formation. One child required a temporary shift from PD to HD because of severe abdominal pain. One patient experienced a recurrent AP after 21 months from the first episode. There were no deaths related to AP.

Conclusions

Children on dialysis show a significantly increased risk for AP compared with the general pediatric population (estimated incidence rate of about 0.15/1000 person/years). An even higher risk is observed in children maintained on chronic HD and in those with neurological co-morbidities.

release  1
pubblicata il  04 maggio 2016 
da Enrico Vidal¹, Irene Alberici¹, Marida Martino², Stefano Picca³, Carmine Pecoraro⁴, Ciro Corrado⁵, Ilse Maria Ratsch⁶, Enrico Verrina⁷, on behalf of the Italian registry of Paediatric Chronic Dialysis
(¹Nefrologia Pediatrica, Dialisi e Trapianto. Dipartimento per la Salute della Donna e del Bambino. Azienda Ospedaliera-Università di Padova; ²Nefrologia e Dialisi, Ospedale Pediatrico "Giovanni XXIII", Bari; ³SSD Dialisi Pediatrica, Ospedale Pediatrico Bambino Gesù, Roma; ⁴Dipartimento di Nefro-Urologia, Ospedale Pediatrico Santobono-Pausilipon, Napoli; ⁵UO di Nefrologia Pediatrica, Ospedale Civico "Di Cristina Benfratelli", Palermo; ⁶Clinica Pediatrica, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona; ⁷Unità di Dialisi Pediatrica, Istituto Giannina Gaslini, Genova)
Parole chiave: comorbidità, pancreatite
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