CAPD and Pancreatitis: No Connection

Abstract

Autopsy studies have shown that approximately 56% of patients on long-term continuous ambulatory peritoneal dialysis (CAPD) develop various pancreatic abnormalities, such as acute and chronic pancreatitis, fibrosis, and acinar dilatation. This prevalence of anatomical abnormalities is similar to that observed in patients on hemodialysis and higher than that in those with normal renal function. However, clinical acute pancreatitis is an uncommon complication of CAPD (0.9%), and this prevalence is similar to that (1.7%) of patient son hemodialysis. We can attribute acute pancreatitis in CAPD patients to no single factor. Perhaps preexisting anatomical abnormalities of the pancreas make the CAPD patient susceptible to acute pancreatitis when exposed to a variety of physiological and non physiological influences. The diagnosis of acute pancreatitis in CAPD patients is difficult, because symptoms and signs are similar to those of dialysis-associated peritonitis. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100 U/L suggest the diagnosis of acute pancreatitis. Serum lipase, isoamylase, and pancreatic secretory trypsin inhibitor are not helpful. In confirming the diagnosis, a computed tomography (CT) scan is more helpful than ultrasound, although it is positive in only 50–60% of cases. One should harbor a high index of suspicion concerning acute pancreatitis if a CAPD patient presenting with suspected peritonitis has either a negative effluent culture or does not respond to antibiotic therapy.

Fulminant Acute Pancreatitis in a Patient with Familial Mediterranean Fever on CAPD: What Caused the Pancreatitis?

“…Notably, serum amylase activity is usually elevated in CAPD patients with pancreatitis (9,10); however, serum amylase level was normal in the present patient. Normal serum amylase level was also previously reported in 5 of 23 CAPD patients with simultaneous acute pancreatitis (11); therefore, an elevated serum amylase level is strongly indicative of acute pancreatitis. Normal levels, however, do not essentially rule out the diagnosis of acute pancreatitis (12).…”

JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis

“…Other reports have shown the occurrence of acute pancreatitis following extracorporeal shock wave lithotripsy (ESWL) for gallbladder stones (2%),62 following transcatheter arterial embolization (TAE, 33%),63 following percutaneous biliary drainage (PBD) (24% developed postprocedural hyperamylasemia and 10% developed postoperative acute pancreatitis),64 following biliary stent insertion (11.5F stent, 3%; 10F stent, none),65 following intraoperative irradiation (2/98, 2%),66 and following continuous ambulatory peritoneal dialysis (CAPD) (0.46 per 100 treatment‐years) 67. However, it remains unclear whether these procedures increase the risk of acute pancreatitis 68…”

Risk of and Fatality from Acute Pancreatitis in Long-Term Hemodialysis and Peritoneal Dialysis Patients

“…Differences in study era and study design might explain the discrepancy. In addition, Gupta et al suggested that the increased AP incidence could be due to a cluster effect rather than a true increase (22). Caruana et al postulated that the pancreas can be irritated by the acidity and hypertonicity of peritoneal dialysate, through the peritoneum of the lesser sac to the anterior surface of the pancreas (7).…”