Acute Hydrothorax in Continuous Ambulatory Peritoneal Dialysis – A Collaborative Study of 161 Centers

Abstract

Follow-up studies on 3,195 patients from 161 centers in Japan undergoing continuous ambulatory peritoneal dialysis (CAPD) were performed for 1–104 months to clarify the incidence as well as the clinical features of acute hydrothorax. In these studies, 50 patients (1.6%) developed this complication. Twenty-seven (54%) were men, and 23 (46%) were women, ranging in age form 6 to 79 (average 49) years. The interval between onset of CAPD and hydrothorax ranged from 1 day to 8 years. Four had left-sided, and 2 had bilateral hydrothorax, but the majority (88%) were right-sided. Dyspnea was experienced by 37 of these 50 patients, but the remaining 13 (26%) patients were asymptomatic. Hydrothorax was fully resolved in 27 of them following a brief interruption of CAPD or the combined use of small exchange volumes in a semi-sitting position and pleurodesis with tetracycline or other agents. The remaining 23 patients (46%) were switched to hemodialysis permanently. Despite recurrence, 1 patient continued successfully on CAPD. It was concluded that acute hydrothorax is one important possible complication, although the risk may be low. Constant surveillance is necessary to detect pleural effusions in patients during CAPD.

The management of benign non-infective pleural effusions

“…This complication is reported to affect 1.6% of patients receiving chronic ambulatory peritoneal dialysis and may be indicated by a reduction in the adequacy of peritoneal dialysis. The development of pleural effusion may occur around the time of peritoneal dialysis initiation or much later; 50% of effusions arise within 30 days of peritoneal dialysis initiation [38]. The biochemistry of pleural fluid in such cases will characteristically represent the constituents of the peritoneal dialysate, typically with very low protein and lactate dehydrogenase.…”

Hidrotórax masivo en un caso de síndrome urémico hemolítico: tratamiento conservador sin interrupción de la diálisis peritoneal

“…Predomina en mujeres y del lado derecho. [1][2][3][4][5][6][7][8][9][10] Un líquido pleural con alto contenido de glucosa en relación con el suero es diagnóstico.…”

“…1,3,[5][6][7][8][9][10] El hidrotórax pediátrico es de baja prevalencia en dializados crónicos y la mayoría de los casos descritos en la literatura corresponde a pacientes con SUH en DP aguda. 2,4,7,8 En la Tabla 2, se detallan las características clínicas de estos pacientes comunicados en un período de 28 años. La incidencia ha sido reportada en 20%, 7 5%, 8 y 3%.…”

“…La incidencia comunicada en casos adultos y pediátricos oscila entre el 1,6%-10% 1-3 y el 0,6%-13%, respectivamente. 2,[4][5][6][7][8][9] El síndrome urémico hemolítico (SUH) es la principal causa de falla renal intrínseca pediátrica. Aproximadamente, 50% de los pacientes necesitan diálisis aguda y la modalidad preferida es la peritoneal.…”

“…7,8 Ante el diagnóstico de un hidrotórax, la mayoría de los pacientes suelen interrumpir la DP y son transferidos a hemodiálisis. [1][2][3][4] Con menor frecuencia, es posible continuarla con alguna modificación de la técnica. 8,10 Se describe el caso de una niña con SUH en DP aguda que se complicó con un hidrotórax masivo resuelto con tratamiento conservador sin interrupción de la DP.…”