title: Exocrine pancreatic function in patients with end-stage renal disease.
abstract: OBJECTIVE
  malnutrition is a common problem in patients with end-stage renal disease (ESRD). Several studies showed 30 years ago that more than half of patients with ESRD suffered from exocrine pancreatic insufficiency. However, the studies never investigated whether the functional impairments led to morphological changes of the pancreas or to steatorrhea and thus indicating the need for lifelong pancreatic enzyme substitution. Our goal was therefore not only to establish the frequency but also the severity of exocrine pancreatic insufficiency in hemodialysis patients.
  
  
  METHODS
  the study included 50 hemodialysis patients with no history of acute or chronic pancreatitis or upper abdominal symptoms of uncertain origin. All patients with hyperthyroidism, status post-gastrectomy or (partial) small bowel resection, or chronic inflammatory bowel disease were excluded. In all 50 patients, fecal elastase-1 was determined using two different methods (Bioserv Diagnostics and ScheBo Biotech) and fecal fat content and fecal weight were measured.
  
  
  RESULTS
  mild to moderate exocrine pancreatic insufficiency (elastase-1 100 - 200 microg/g stool) was found in 10% of patients. It was not correlated with age, sex, and underlying renal disease, duration of hemodialysis, or diarrhea and steatorrhea. In no patient was the enzyme content < 100 microg/g stool, i.e., it never sank to a level at which pancreatic enzyme substitution would have been recommended. Nine patients (18%) had mild diarrhea (200 - 300 g stool/ day), and 10 (20%) had mild steatorrhea (7 - 15 g fat/day in the stool). Five patients had both diarrhea and steatorrhea.
  
  
  CONCLUSIONS
  mild to moderate but not severe exocrine pancreatic insufficiency is not infrequent in patients on hemodialysis but unlikely to be responsible for malnutrition in ESRD. Non-pancreas-related steatorrhea is also not uncommon. This finding requires further analysis because steatorrhea might influence nutrition, thus potentially opening the way to new therapeutic approaches.
authors.affiliation: Practice for Nephrology and Dialysis, University of Göttingen, Göttingen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Griesche-Philippi
authors.forename: J
authors.initials: J
authors.lastname: Otto
authors.forename: H
authors.initials: H
authors.lastname: Schwörer
authors.forename: P
authors.initials: P
authors.lastname: Maisonneuve
authors.forename: P G
authors.initials: PG
authors.lastname: Lankisch
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000209:etiology; D010188:Exocrine Pancreatic Insufficiency / Q000201:enzymology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005243:Feces / Q000201:enzymology; D005260:Female; D005858:Germany; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000201:enzymology / Q000503:physiopathology / Q000628:therapy*; D008055:Lipids / Q000032:analysis; D008297:Male; D044342:Malnutrition / Q000201:enzymology / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D009752:Nutritional Status; D046790:Pancreas, Exocrine / Q000201:enzymology*; D010196:Pancreatic Elastase / Q000032:analysis*; D006435:Renal Dialysis; D012720:Severity of Illness Index; D045602:Steatorrhea / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D008055:Lipids; D010196:Pancreatic Elastase