TRYPSINOGEN AND OTHER PANCREATIC-ENZYMES IN PATIENTS WITH RENAL-DISEASE - A COMPARISON OF HIGH-EFFICIENCY HEMODIALYSIS AND CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Although serum amylase and lipase levels have been studied extensively in patients with renal disease, there are fewer data regarding trypsi nogen levels in patients with end-stage renal disease (ESRD) treated w ith different dialytic modalities. We therefore evaluated the blood co ncentrations of trypsinogen, amylase, and lipase in asymptomatic patie nts with chronic renal insufficiency (CRI) and ESRD, to determine whet her treatment modality or renal handling of these enzymes is important in determining steady-state levels in asymptomatic patients with chro nic renal disease, Mean trypsinogen concentration levels were higher i n hemodialysis (HD) patients and patients with CRI compared with norma l subjects when values in the different groups were compared. There wa s no difference in the mean trypsinogen levels between patients treate d with HD and those with CRI, between patients treated with chronic am bulatory peritoneal dialysis (CAPD) and those treated with HD, or betw een CAPD patients and patients with CRI. The mean circulating trypsino gen concentration was elevated more frequently and to a higher level t han amylase or lipase in patients with CRI and ESRD, HD treatment did not result in a lowering of mean circulating pancreatic enzyme levels. We propose that decreased peripheral clearance, pancreatic overproduc tion, increased release from the pancreas, or a combination of these m echanisms is responsible, at least in part, for the increased plasma c oncentration of trypsinogen in patients with CRI, rather than simply a decrease in renal clearance.