Acute Pancreatitis in Advanced Chronic Kidney Disease and Kidney Transplant Recipients: Results of a US Nationwide Analysis

• Published in: Mayo Clinic proceedings. Innovations, quality & outcomes Vol. 3; no. 2; pp. 160 - 168
• Main Authors: Kroner, Paul T., Mareth, Karl, Raimondo, Massimo, Lee, David D., Alsaad, Ali, Aslam, Nabeel, Abader, Peter, Wadei, Hani M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.06.2019; Elsevier
• Subjects: Original; ESRD; OR; ICD-9-CM; CKD5; CCI; NIS; ERCP; ICU; CKD; US; AP; CKD5, stage 5 CKD; ERCP, endoscopic retrograde cholangiopancreatography; ICU, intensive care unit; CCI, Charlson Comorbidity Index; NIS, Nationwide Inpatient Sample; AP, acute pancreatitis; ESRD, end-stage renal disease; OR, odds ratio; CKD, chronic kidney disease; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; US, ultrasonography
• ISSN: 2542-4548; 2542-4548
• DOI: 10.1016/j.mayocpiqo.2019.03.006

To study the prevalence, etiology, and outcome of acute pancreatitis (AP) in kidney transplant and stage 5 chronic kidney disease (CKD) populations in comparison to a non-CKD cohort. Using the Nationwide Inpatient Sample database, we identified patients with acute pancreatitis as the primary discharge diagnosis, after which propensity scores were used to create 2 cohorts of patients: 1 with CKD (n=13,425) and 1 without CKD (n=13,425). The CKD group was subsequently subdivided into dialysis-independent stage 5 CKD (n=690), dialysis-dependent stage 5 CKD (n=11,415), and kidney transplant recipients (n=1320). Patients younger than 18 years old, those who received a kidney transplant during the incident admission, and pancreas transplant recipients were excluded. The adjusted odds ratios (ORs) of AP were comparable between the no CKD, stage 5 CKD, and kidney transplant populations. Adjusted inpatient mortality was highest in patients with dialysis-dependent stage 5 CKD (OR, 2.72; 95% CI, 2.2-3.3; P<.01), followed by kidney transplant recipients (OR, 2.29; 95% CI, 1.12-4.51; P=.02), compared to the non-CKD group. Patients with stage 5 CKD experienced higher rates of shock and intensive care unit admission and had more prolonged and costly hospitalizations than the non-CKD group (P<.01 for all). Hypercalcemia was the most common cause of AP in both dialysis-dependent and dialysis-independent patients with stage 5 CKD, while viral and drug-induced pancreatitis were more prevalent in the transplant recipients. Despite comparable adjusted prevalence of AP among the stage 5 CKD, transplant, and non-CKD populations, mortality, morbidity, and resource utilization were higher in the patients with stage 5 CKD and transplant recipients. Hypercalcemia is the most common cause of AP in the stage 5 CKD population irrespective of dialysis requirement.