Dialysis-related constrictive pericarditis: old enemies may sometimes come back

Abstract

Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD). Several heart conditions have been associated with CKD, including myocardial and pericardial diseases. This paper describes a case of Dialysis-related constrictive pericarditis in a patient diagnosed with sudden hypotension during a hemodialysis session. A 65-year-old man diagnosed with hypertension, diabetes, obesity, and cirrhosis on hemodialysis for two years complained of symptoms during one of his sessions described as malaise, lipothymia, and confusion. The patient had a record of poor compliance with the prescribed diet and missed dialysis sessions. He was sluggish during the physical examination, and presented hypophonetic heart sounds, a blood pressure of 50/30mmHg, and a prolonged capillary refill time. The patient was referred to the intensive care unit and was started on antibiotics and vasoactive drugs. His workup did not show signs of infection, while electrocardiography showed low QRS-wave voltage. His echocardiogram showed signs consistent with a thickened pericardium without pericardial effusion. Cardiac catheterization showed equalization of diastolic pressures in all heart chambers indicative of constrictive pericarditis. The patient underwent a pericardiectomy. Examination of surgical specimens indicated he had marked fibrosis and areas of dystrophic calcification without evidence of infection, consistent with Dialysis-related constrictive pericarditis. Hypotension for unknown causes must be considered in the differential diagnosis of dialysis patients.

Cardiac Tamponade in a Chronic Renal Failure Patient with Suspicion of Dialysis Pericarditis: A Case Report

“…The two main causes of pericarditis in hemodialysis patients are dialysisrelated pericarditis and uremic pericarditis (Lee et al, 2021). Uremic pericarditis is defined as pericarditis that occurs before or within eight weeks of starting dialysis, while dialysisrelated pericarditis is defined as pericarditis that occurs in patients who have been on dialysis for >8 weeks (Neves et al, 2021). The occurrence of pericarditis is due to the accumulation of toxic metabolites and nitrogen in the blood which causes the release of pro-inflammatory mediators such as interleukin 1, interleukin 6, and tumor necrosis factor (TNF) resulting in inflammation, fibrous deposition, and adhesions that cause damage to the pericardium tissue resulting in cardiac tamponade that endangers the patient's life (Yacoub et al, 2021;Awan et al, 2017;.…”

Hemodialysis-Related Pericarditis With Cardiac Tamponade

“…Two leading causes of pericarditis in patients on hemodialysis are dialysis-related pericarditis and uremic pericarditis [ 8 ]. Uremic pericarditis is defined as pericarditis that occurs before or within eight weeks of initiating dialysis, while dialysis-related pericarditis is defined as pericarditis that occurs in patients who have been on dialysis for >8 weeks [ 9 ]. In the current patient, pericardial effusion was observed initially.…”