Clinical course of acute pancreatitis in chronic kidney disease patients in a single kidney center (PGTi) in Karachi.

INTRODUCTION: The aim of this study was to assess the clinical course, etiology and complications of acute pancreatitis among chronic kidney disease (CKD) patients in a tertiary care renal center in Karachi. METHODS: We retrospectively evaluated the clinical course of CKD patients who presented to our emergency room with signs and symptoms of acute pancreatitis over a period of two years. RESULTS: During the study period, 247 CKD patients presented to our emergency room with symptoms suggestive of acute pancreatitis. Only 43 patients (17.4%) had more than a threefold increase in serum amylase and/or lipase levels fulfilling the diagnostic criteria of acute pancreatitis. They included 25 pre-dialysis CKD patients (58.13%) and 18 end stage renal failure patients (41.86%) on regular hemodialysis (HD). Among the 25 pre-dialysis CKD patients, 17 patients developed acute kidney injury (AKI), ten of whom required temporary HD. Twelve of those patients (70%) returned back to their baseline renal functions after 3-4 weeks. Gallstones were the cause of pancreatitis in seven patients (16.3%) while no cause was identified in 29 patients (67.4%). Nine patients (20.9%) developed multi-organ failure and 12 patients (27.9%) required admission to the intensive care unit (ICU). All patients survived except for one patient (2.3%) who died in the ICU. patients with less than threefold increase in serum amylase and lipase levels responded well to conservative management and had a favorable clinical course. CONCLUSION: In severe acute pancreatitis the mortality rate can be as high as 40-58% especially in association with comorbid conditions. In this series of CKD patients however, the overall mortality rate was 2.3%, probably due to the predominance of milder forms of pancreatitis.

Biochemical nutritional parameters and their impact on hemodialysis efficiency.

To determine the nutritional status of chronic hemodialysis (HD) patients and the association of changes in serum albumin levels, C-reactive protein (CRP), low density lipoprotein (LDL) cholesterol and body mass index (BMI) as indicators of nutritional status with the urea reduction ratio (URR) during dialysis, we studied 201 chronic HD patients (97 males and the mean age was 51 +/- 15 years). Diabetes was the cause of chronic kidney disease (CKD) in 34% of the patients, hypertension in 57%, chronic glomerulonephritis in 12%, and obstructive uropathy in 10%. BMI less than 18.5 (under weight) was found in 17% of patients, more 18.5 but less than 25 (normal) in 56%, more than 25 but less than 30 (overweight) in 21%, and more than 30 (obese) in 6%. The laboratory investigations revealed hypercalcemia in 62% of the patients (15 patients were found to have tertiary hyperparathyroidism), total cholesterol less than 100 mg/dL in 6% (mean 152 +/- 37.5 mg/dL), and URR of less than 60% in 12% of patients and greater than 60 but less than 65% in 33%. Hypoalbuminemia was associated with poor URR (P < 0.05), whereas no statistically significant correlation was found between URR and iPTH, LDL cholesterol, CRP and body mass index. We conclude that poor nutritional status was detected among a significant number of our patients with poor dietary education. Increased risk of malnutrition was significantly associated with older age and inadequate dialysis dose. Hypoalbuminemia was the single most important factor associated with poor URR.