title: Epidemiology and outcome of acute pancreatitis in end-stage renal disease dialysis patients: a 10-year national cohort study.
abstract: BACKGROUND
  The objective of this study is to determine the incidence and severity of acute pancreatitis (AP) in patients with end-stage renal disease (ESRD) on dialysis and whether the dialysis modality [hemodialysis (HD) versus peritoneal dialysis (PD)] confers a higher risk for AP as well as complications or mortality related to AP.
  
  
  METHODS
  We analyzed national health insurance claims data of 67 078 ESRD patients initiating dialysis between 1999 and 2007 in Taiwan. All patients were followed up from the start of their dialysis to first AP diagnosis, death, end of dialysis or 31 December 2008. Cox proportional hazards models were used to identify risk factors.
  
  
  RESULTS
  The cumulative incidence rates of AP were 0.6, 1.7, 2.6, 3.4 and 4% at 1, 3, 5, 7 and 9 years, respectively. ESRD patients on HD and PD had an AP incidence of 5.11 and 5.86 per 1000 person-years, respectively. Independent risk factors for AP in this population were being elderly, being female, having biliary stones or liver disease, and being on PD. Severe AP occurred in 44.9% of the HD patients and in 36% of the PD patients. Patients with AP on HD had a higher incidence of upper gastrointestinal (UGI) bleeding than those on PD (P = 0.002). In contrast, those with AP on PD had a higher incidence of need for total parenteral nutrition (TPN) support than those on HD (P = 0.072). Overall in-hospital mortality was 8.1%. The risk factors for mortality after an AP attack were male gender, increased age, AP severity, and the presence of diabetes mellitus or liver disease.
  
  
  CONCLUSIONS
  ESRD patients on PD were at higher risk for AP than those on HD. HD patients with AP attacks had a greater incidence of UGI bleeding and PD patients with AP attacks a more frequent need for TPN support.
authors.affiliation: Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Division of Controlled Drugs, Food and Drug Administration, Ministry of Health and Welfare, Taiwan.
authors.forename: Wen-Ing
authors.initials: WI
authors.lastname: Tsay
authors.affiliation: Division of Controlled Drugs, Food and Drug Administration, Ministry of Health and Welfare, Taiwan.
authors.forename: Shwu-Huey
authors.initials: SH
authors.lastname: Her
authors.affiliation: Department of Gastroenterology and Hepatology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Cheng-Heng
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Chien
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality*; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: acute pancreatitis; dialysis; end-stage renal disease; outcome