Clinical Course of Acute Pancreatitis in Chronic Kidney Disease Patients in a Single Kidney Center (PGTi) in Karachi

Introduction: The aim of this study was to assess the clinical course, etiology and complications of acute pancreatitis among chronic kidney disease (CKD) patients in a tertiary care renal center in Karachi. Methods: We retrospectively evaluated the clinical course of CKD patients who presented to our emergency room with signs and symptoms of acute pancreatitis over a period of two years. Results: During the study period, 247 CKD patients presented to our emergency room with symptoms suggestive of acute pancreatitis. Only 43 patients (17.4%) had more than a threefold increase in serum amylase and/ or lipase levels fulfilling the diagnostic criteria of acute pancreatitis. They included 25 pre-dialysis CKD patients (58.13%) and 18 end stage renal failure patients (41.86%) on regular hemodialysis (HD). Among the 25 pre-dialysis CKD patients, 17 patients developed acute kidney injury (AKI), ten of whom required temporary HD. Twelve of those patients (70%) returned back to their baseline renal functions after 3-4 weeks. Gallstones were the cause of pancreatitis in seven patients (16.3%) while no cause was identified in 29 patients (67.4%). Nine patients (20.9%) developed multi-organ failure and 12 patients (27.9%) required admission to the intensive care unit (ICU). All patients survived except for one patient (2.3%) who died in the ICU. patients with less than threefold increase in serum amylase and lipase levels responded well to conservative management and had a favorable clinical course. Conclusion: In severe acute pancreatitis the mortality rate can be as high as 40-58% especially in association with comorbid conditions. In this series of CKD patients however, the overall mortality rate was 2.3%, probably due to the predominance of milder forms of pancreatitis.