Exocrine pancreatic function in patients with end-stage renal disease

J. Griesche-Philippi, J. Otto, H. Schwörer, P. Maisonneuve, P. G. Lankisch

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: Malnutrition is a common problem in patients with end-stage renal disease (ESRD). Several studies showed 30 years ago that more than half of patients with ESRD suffered from exocrine pancreatic insufficiency. However, the studies never investigated whether the functional impairments led tomorphological changes of the pancreas or to steatorrhea and thus indicating the need for lifelong pancreatic enzyme substitution. Our goalwas therefore not only to establish the frequency but also the severity of exocrine pancreatic insufficiency in hemodialysis patients. Methods: The study included 50 hemodialysis patients with no history of acute or chronic pancreatitis or upper abdominal symptoms of uncertain origin. All patients with hyperthyroidism, status post-gastrectomy or (partial) small bowel resection, or chronic inflammatory bowel disease were excluded. In all 50 patients, fecal elastase-1 was determined using two different methods (Bioserv Diagnostics and ScheBo Biotech) and fecal fat content and fecal weight were measured. Results: Mild to moderate exocrine pancreatic insufficiency (elastase-1 100-200 μg/g stool) was found in 10% of patients. It was not correlated with age, sex, and underlying renal disease, duration of hemodialysis, or diarrhea and steatorrhea. In no patient was the enzyme content <100 μg/g stool, i.e., it never sank to a level at which pancreatic enzyme substitution would have been recommended. Nine patients (18%) had mild diarrhea (200 - 300 g stool/day), and 10 (20%) had mild steatorrhea (7-15 g fat/day in the stool). Five patients had both diarrhea and steatorrhea. Conclusions: Mild to moderate but not severe exocrine pancreatic insufficiency is not infrequent in patients on hemodialysis but unlikely to be responsible for malnutrition in ESRD. Non-pancreas-related steatorrhea is also not uncommon. This finding requires further analysis because steatorrhea might influence nutrition, thus potentially opening the way to new therapeutic approaches.

Original languageEnglish
Pages (from-to)457-464
Number of pages8
JournalClinical Nephrology
Volume74
Issue number6
Publication statusPublished - Dec 2010

Keywords

  • Acute pancreatitis
  • Dialysis
  • Hemodialysis
  • Peritoneal dialysis

ASJC Scopus subject areas

  • Nephrology

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