Review Articles: Management Options for Hydrothorax Complicating Peritoneal Dialysis

Abstract

Hydrothorax as a result of pleuroperitoneal communication occurs in approximately 2% of continuous ambulatory peritoneal dialysis (CAPD) patients. Although our understanding of its mechanisms is incomplete, it is apparent that the key to successful therapy is obliteration of a transdiaphragmatic route of dialysate leakage (pleuroperitoneal communication), possibly coupled with reduction of intra-abdominal pressure. This review corroborated the findings from 10 major population-based case series in which 60 of the 104 cases (58%) were able to resume long-term peritoneal dialysis (PD). Temporary interruption of PD alone was successful in half of them. As compared to this conservative approach, as well as chemical pleurodesis via intercostal chest drain, video-assisted thoracoscopic intervention (including direct pleurodesis and diaphragmatic repair) has shown a promising role. Efficacy of thoracoscopic treatment has been confirmed by several case series from various centers and the demonstration of a success rate in excess of 90%. With accumulating experience using the thoracoscopic technique, it remains to be seen whether this mode of treatment will obviate the traditional closed pleurodesis.

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.…”

“…1,3,4,11,12 Se supone que una presión abdominal elevada podría ser un factor patogénico relevante, por lo que se han propuesto medidas dialíticas para disminuirla: iniciar la DP con volúmenes bajos, aumento progresivo, acortamiento del tiempo de permanencia, diálisis cíclica con día seco, posición sentada. 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.…”

“…3,[6][7][8][9][10] Sin embargo, no siempre resulta exitosa 2,6,7,13,14 y el abandono de la DP es elevado.…”

“…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.…”

Atypical Pleural Effusions in Patients on Peritoneal Dialysis

“…A prompt diagnosis of hydrothorax due to dialysate is required to prevent exacerbation of symptoms and recurrence, but more importantly to prevent unnecessary diagnostic imaging and other procedures as it is so unusual. Other than apparent loss of ultrafiltration [10], investigations that may aid in diagnosis include CXR, paracentesis with analysis of pleural-to-serum glucose and LDH levels, computerized tomography, magnetic resonance, and scintigraphy [11]. Conservative management of the pleuroperitoneal leak has been reported [12] using lower fill volumes or temporary conversion to hemodialysis for a "PD rest".…”