DIAGNOSTIC CHALLENGES OF PANCREATITIS IN CKD: EFFECT OF RENAL DYSFUNCTION ON AMYLASE AND LIPASE LEVELS

Abstract

This study aims to investigate pancreatic enzyme levels in CKD patients with and without dialysis to determine an association between pancreatic enzymes and chronic renal failure. Also to quantify the percent increase in pancreatic enzyme in CKD since, there is a lack of concise data from Pakistan on the relationship between pancreatic enzymes and CKD or end-stage renal disease (ESRD) due to insufficient local studies. However, the diagnosis of pancreatitis in CKD patients is challenging due to elevated pancreatic enzyme levels with reduced estimated glomerular filtration rates (eGFR). 

Method: This is a cross-sectional study conducted in the nephrology department of Liaquat National Hospital, Pakistan. Serum amylase, lipase, and creatinine levels were measured in all participants. Serum amylase and lipase above 140 U/L were considered elevated. The Cockcroft-Gault formula was used to calculate eGFR and a cut-off less than 60 mL/min/1.73 m² was labeled as CKD. Data were analyzed using SPSS version 25, with a p-value of < 0.01 considered statistically significant.

Results: The study included 196 CKD +/- dialysis patients. The mean serum creatinine level was 5.41 ± 3.30 mg/dl, and the mean eGFR was 13.5 mL/min/1.73 m². 174 (88.7%) of patients had elevated pancreatic enzymes. 174 CKD patients (88.7%)had raised amylase levels and 157 CKD patients (80.1%) had a raised lipase level.

Conclusion:  Elevated amylase and lipase levels are frequently observed in CKD patients, which is not a novel finding. The study findings recommend considering alternative or adjunctive diagnostic modalities such as magnetic resonance imaging (MRI) or endoscopic ultrasound (EUS) for accurate diagnosis of acute pancreatitis in CKD patients.