Acute Hydrothorax Complicating Peritoneal Dialysis

Abstract

Aim To determine whether gradually increasing the peritoneal dialysate fill volume from 10 to 40 mL/kg over 6 days, rather than commencing at 40 mL/kg, prevents hydrothorax in children and reverses it if present. Methods A review of children peritoneally dialyzed in a single center. Results During the 20 years beginning June 1985, 416 children were peritoneally dialyzed, of which 327 (79%) had acute and 89 had end-stage renal failure. Among 253 children who had gradually increasing fill volumes, none developed acute hydrothoraces, but 13/163 (8%) who began with 40 mL/kg cycles did ( p < 0.000, Fisher's exact test). These were diagnosed after a median (range) of 48 (6 – 72) hours and were predominantly right sided. Initially, we readily abandoned peritoneal dialysis; 2 were changed to hemodialysis. Subsequently, we found that peritoneal dialysis could be continued by using small volumes with the patients sitting up; cycle volumes were then gradually increased again. One pre-term baby died soon after developing an acute hydrothorax. One patient on chronic peritoneal dialysis developed an acute hydrothorax after forceful vomiting, but recovered after being dialyzed sitting up with low fills. Conclusion Acute hydrothorax can be prevented and treated using graduated cycle volumes, and is not a contraindication for peritoneal dialysis.

Thoracoscopic surgery for management of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis

“…Although the time to resume CAPD is uncertain, pleurodesis as well as gradually increasing the peritoneal dialysate from low-volume exchanges to full-volume exchanges should be attempted in postoperative patients who are seated or propped upright. [10,11]…”

Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis

“…We performed manual PD using Tenckhoff catheters and bicarbonate-based dialysate, typically with 30-min cycles. In the piglets we used 40-ml/kg fill volumes, but to minimise the risk of acute hydrothorax in the babies we commenced at 10 ml/kg and aimed to increase to 40 ml/kg over 6 days if tolerated [ 19 ].…”

Hydrothorax: Pleural Effusion Associated with Peritoneal Dialysis

“…Elevated intra-abdominal pressure predisposes the patient to hernias or thinning of the diaphragm. High volume (40 mL/kg) PD exchange at initiation in children causes more hydrothorax compared to those children starting with low volumes (10 mL/kg) (14).…”