I-Kuan Wang1,2,3, Shih-Wei Lai4, Hsueh-Chou Lai5, Cheng-Li Lin6,7, Tzung-Hai Yen7,8, Che-Yi Chou3, Chiz-Tzung Chang3, Chiu-Ching Huang3, Fung-Chang Sung9,6,10. 1. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. 2. Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan. 3. Division of Nephrology, China Medical University Hospital, Taichung, Taiwan. 4. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. 5. Division of Gastroenterology, China Medical University Hospital, Taichung, Taiwan. 6. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan. 7. Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan. 8. Chang Gung University College of Medicine, Taoyuan, Taiwan. 9. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan fcsung1008@yahoo.com. 10. Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan.
Abstract
BACKGROUND: This study was conducted to evaluate the risk of developing acute pancreatitis (AP) and the fatality from AP in hemodialysis (HD) and peritoneal dialysis (PD) patients, using the claims data of Taiwan National Health Insurance. METHODS: From patients with newly diagnosed end-stage renal disease (ESRD) in 2000-2010, we identified a PD cohort (N = 9,766), a HD cohort (N = 18,841), and a control cohort (N = 114,386) matched by sex, age, and the diagnosis year of the PD cohort. We also established another 2 cohorts with 9,744 PD patients and 9,744 propensity score-matched HD patients. The incident AP and fatality from AP were evaluated for all cohorts by the end of 2011. RESULTS: The adjusted hazard ratios (HRs) of acute pancreatitis were 5.68 (95% confidence interval [CI] = 5.05 - 6.39), 4.91 (95% CI = 4.32 - 5.59), and 7.47 (95% CI = 6.48 - 8.62) in the all dialysis, HD, and PD patients, compared with the controls, respectively. Peritoneal dialysis patients had an adjusted HR of 1.41 (95% CI = 1.21 - 1.65) for AP, compared with propensity score-matched HD patients. Peritoneal dialysis patients under icodextrin treatment had a lower incidence of AP than those without the treatment, with an adjusted HR of 0.59 (95% CI = 0.47 - 0.73). There was no significant difference in the 30-day mortality from AP between HD and PD patients. CONCLUSIONS: Peritoneal dialysis patients were at a higher risk of developing AP than HD patients. Icodextrin solution could reduce the risk of developing AP in PD patients.
BACKGROUND: This study was conducted to evaluate the risk of developing acute pancreatitis (AP) and the fatality from AP in hemodialysis (HD) and peritoneal dialysis (PD) patients, using the claims data of Taiwan National Health Insurance. METHODS: From patients with newly diagnosed end-stage renal disease (ESRD) in 2000-2010, we identified a PD cohort (N = 9,766), a HD cohort (N = 18,841), and a control cohort (N = 114,386) matched by sex, age, and the diagnosis year of the PD cohort. We also established another 2 cohorts with 9,744 PDpatients and 9,744 propensity score-matched HDpatients. The incident AP and fatality from AP were evaluated for all cohorts by the end of 2011. RESULTS: The adjusted hazard ratios (HRs) of acute pancreatitis were 5.68 (95% confidence interval [CI] = 5.05 - 6.39), 4.91 (95% CI = 4.32 - 5.59), and 7.47 (95% CI = 6.48 - 8.62) in the all dialysis, HD, and PDpatients, compared with the controls, respectively. Peritoneal dialysis patients had an adjusted HR of 1.41 (95% CI = 1.21 - 1.65) for AP, compared with propensity score-matched HDpatients. Peritoneal dialysis patients under icodextrin treatment had a lower incidence of AP than those without the treatment, with an adjusted HR of 0.59 (95% CI = 0.47 - 0.73). There was no significant difference in the 30-day mortality from AP between HD and PDpatients. CONCLUSIONS: Peritoneal dialysis patients were at a higher risk of developing AP than HDpatients. Icodextrin solution could reduce the risk of developing AP in PDpatients.