Serum level of amylase and lipase in various stages of chronic renal insufficiency.

BACKGROUND

Twenty percent of pancreatic enzymes is excreted by the kidneys. Thus, patients with end stage renal disease (ESRD) have elevated levels of serum pancreatic enzymes. The purpose of this study was to evaluate the changes of serum pancreatic enzyme levels in patients with various stages of ESRD undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) as well as those treated conservatively.

METHODS

Serum pancreatic enzyme levels were determined in 96 cases, including 19 healthy controls, 28 cases of ESRD treated conservatively and 49 uremic cases receiving dialytic treatment (37 hemodialysis and 12 CAPD).

RESULTS

The mean activity of serum pancreatic enzymes was significantly higher in patients with ESRD compared to that in the healthy controls (p < 0.0001). Out of 28 patients, ESRD patients had serum amylase and lipase levels higher than normal in 17 (60.7%) and 16 (57.1%) cases respectively. Eight out of 12 CAPD cases (66.7%) had higher levels of both enzymes. However, 31/37 (83.7%) and 32/37 (86.5%) HD patients had elevated levels of serum amylase and lipase, respectively. Only 1 (1.3%) and 4(5.2%) out of 77 ESRD cases had threefold elevated levels of amylase and lipase, respectively.

CONCLUSIONS

Serum pancreatic enzymes are often elevated within threefold normal in ESRD patients. Thus, acute pancreatitis must be considered if enzyme levels are more than threefold normal in association with clinical manifestiations.