| Abstract [eng] |
Acute pancreatitis is a pathology with complex diagnostics, an insidious disease course, and a steadily increasing incidence and mortality each year. Patients with chronic kidney disease are considered to be at increased risk of developing acute pancreatitis, while those undergoing peritoneal dialysis face an even highier risk due to several contributing factors: underlying chronic kidney disease, its progression to end-stage renal disease, the dialysis process itself, and specific pathophysiological mechanisms associated with peritoneal dialysis, all of which enhance the predisposition to acute pancreatitis. However, due to the rarity of this condition in the context of peritoneal dialysis, the exact prevalence, mortality rates, underlying mechanisms, and clinical course remain insufficiently studied. The most frequently cited pathophysiological mechanisms include hypercalcemia, hyperlipidemia, and local inflammation caused by components of the dialysate. To confirm the diagnosis of acute pancreatitis, at least two of the following criteria must be met: characteristic clinical presentation, a serum lipase and/or amylase elevation greater than threefold, or confirmation of acute pancreatitis through imaging studies. Patients receiving peritoneal dialysis are distinguished by the fact that changes in the appearence of the dialysate may serve as an additional indicator that can facilitate earlier suspicion and diagnosis of the disease. However, serum pancreatic enzyme levels un this patient group are not entirely reliable, making imaging studies frequently necessary to confirm the diagnosis. The main apsects of acute pancreatitis treatment do not substantially differ from those applied in the general patient population, except that fluid therapy must be carefully measured, and individualized due to impaired renal function. The prognosis depends on the type of pancreatitis and the extent and severity of complications. Necrotizing pancreatitis and infectious complications are associated with increased morbidity and mortality. This paper presents two rare clinical cases of acute pancreatitis in patients undergoing peritoneal dialysis and provides a literature review covering the latest data on the prevalence of acute pancreatitis among peritoneal dialysis patients, associated risk factors, etiopathogenesis, diagnostics, treatment, and patient outcomes and prognosis. |
