Wang I-Kuan, Lai Shih-Wei, Lai Hsueh-Chou, Lin Cheng-Li, Yen Tzung-Hai, Chou Che-Yi, Chang Chiz-Tzung, Huang Chiu-Ching, Sung Fung-Chang
Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Perit Dial Int. 2018 Jan-Feb;38(1):30-36. doi: 10.3747/pdi.2016.00313. Epub 2017 Nov 2.
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.
From patients with newly diagnosed end-stage renal disease (ESRD) in 2000-2010, we identified a PD cohort ( = 9,766), a HD cohort ( = 18,841), and a control cohort ( = 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.
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.
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.
本研究利用台湾国民健康保险的理赔数据，评估血液透析（HD）和腹膜透析（PD）患者发生急性胰腺炎（AP）的风险以及AP导致的死亡率。
从2000年至2010年新诊断为终末期肾病（ESRD）的患者中，我们确定了一个腹膜透析队列（n = 9766）、一个血液透析队列（n = 18841）以及一个按性别、年龄和腹膜透析队列诊断年份匹配的对照队列（n = 114386）。我们还建立了另外两个队列，分别有9744名腹膜透析患者和9744名倾向评分匹配的血液透析患者。到2011年底，对所有队列评估了AP的发病率和AP导致的死亡率。
与对照组相比，所有透析患者、血液透析患者和腹膜透析患者发生急性胰腺炎的校正风险比（HR）分别为5.68（95%置信区间[CI]=5.05 - 6.39）、4.91（95%CI = 4.32 - 5.59）和7.47（95%CI = 6.48 - 8.62）。与倾向评分匹配的血液透析患者相比，腹膜透析患者发生AP的校正HR为1.41（95%CI = 1.21 - 1.65）。接受艾考糊精治疗的腹膜透析患者AP发病率低于未接受治疗的患者，校正HR为0.59（95%CI = 0.47 - 0.73）。血液透析和腹膜透析患者AP的30天死亡率无显著差异。
腹膜透析患者发生AP的风险高于血液透析患者。艾考糊精溶液可降低腹膜透析患者发生AP的风险。
