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Acute pancreatitis in children on chronic maintenance dialysis

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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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Acknowledgments

This paper has been written on behalf of the IRPCD. The authors would like to thank all of the members of Scientific Committee, in particular Ciro Corrado, Mario Giordano, Fabio Paglialonga, Stefano Picca, Carmine Pecoraro, and Ilse Maria Ratsch who kindly provided detailed data of patients enrolled within the Italian cohort.

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Authors and Affiliations

  1. Pediatric 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 & Irene Alberici

  2. Dialysis Unit, IRCCS Giannina Gaslini, Genoa, Italy

    Enrico Verrina

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  1. Enrico Vidal
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  2. Irene Alberici
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  3. Enrico Verrina
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on behalf of the Italian Registry of Pediatric Chronic Dialysis

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Correspondence to Enrico Vidal.

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1. d; 2. b; 3. d; 4. c; 5. a

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Vidal, E., Alberici, I., Verrina, E. et al. Acute pancreatitis in children on chronic maintenance dialysis. Pediatr Nephrol 34, 1501–1512 (2019). https://doi.org/10.1007/s00467-018-4043-y

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