Acute Pancreatitis in Continuous Ambulatory Peritoneal Dialysis (CAPD)

Four patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for uremia developed acute pancreatitis (AP) over a 10-month period. No patient in the comparatively large hemodialysis population developed AP in the past 10 years. Diagnosis of AP was confirmed by the temporal change in the serum amylase levels and/or by radiographic imaging. Peritonitis was excluded by normal peritoneal fluid WBC counts and bacterial culture. Two patients developed tea-colored peritoneal fluid after the onset of the disease. Two patients required discontinuation of peritoneal dialysis (PD) to manage, their symptoms. Total corrected serum calcium was elevated in all four patients. All patients had complicated peritonitis histories. No patient was ingesting any known pancreatic toxin including alcohol and no patient had cholelithiasis or hepatitis.

A literature review reveals 24 other cases of AP in CAPD patients. Of the cases described in detail, only two did not have peritonitis. AP is an entity which is more common in the CAPD population than previously recognized. Although no etiologic associations have been firmly established, hypercalcemia and a previous history of peritonitis may be important.