Spontaneous Resolution of Hydrothorax in Continuous Ambulatory Peritoneal Dialysis

Ing, Austin; Rutland, Joshua; Kalowski, Steven

doi:10.1159/000186892

Cited by 17 publications

(10 citation statements)

References 6 publications

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“…Spontaneous resolution of the complication with subsequent resumption of CAPD has been reported (17,19,22,23,29–33). In the retrospective case series described herein (Table 1), temporary discontinuation of PD was associated with a 53% success rate of resuming long‐term CAPD.…”

Section: Conservative Approach: Interruption Of Pdmentioning

confidence: 99%

Review Articles: Management Options for Hydrothorax Complicating Peritoneal Dialysis

Chow

Szeto

2003

Seminars in Dialysis

139

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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.

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Section: Conservative Approach: Interruption Of Pdmentioning

confidence: 99%

Review Articles: Management Options for Hydrothorax Complicating Peritoneal Dialysis

Chow

Szeto

2003

Seminars in Dialysis

139

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“…The absence of PD fluid in the abdomen decreases intra-abdominal pressure. Withholding PD for 4-6 weeks allows minor imperfections in the diaphragm to heal themselves [21]. Restoration of PD on a trial basis determines whether pleural effusion will reoccur.…”

Section: Discussionmentioning

confidence: 99%

“…Videoassisted thoracoscopic surgery allows for direct visualisation of the diaphragm and malformations in this area and it is reserved as the last treatment option as it is not devoid of risks [27,28]. In general, with both conservative and surgical treatment, up to 58% of patients can continue on PD treatment [21]. However, the relapse rate is generally high, which is why the results with the different treatments are not very encouraging [4,29] and a high percentage of cases require a definitive transfer to HD [30].…”

Section: Discussionmentioning

confidence: 99%

Successful Continuation of Peritoneal Dialysis after "Sweet" Hydrothorax

et al. 2015

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A 44-year-old woman with end-stage renal disease presented with dyspnea on exertion and a vague chest pain about two weeks after commencing continuous ambulatory peritoneal dialysis (CAPD) four months ago. A chest x-ray revealed massive unilateral right-sided pleural effusion. Laboratory analysis of the effusion revealed low protein and lactate dehydrogenase but elevated glucose levels were consistent with transudate and pleuroperitoneal leakage. Pleural glucose concentration was much higher than patients’ serum glucose concentration, which was suggestive of "sweet" hydrothorax because of this high glucose concentration. It is advisable to keep this condition in mind among the differenttial diagnoses of hydrothorax in patients on CAPD.

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“…If subsequently there is no in crease in intra-abdominal pressure, a recurrence is unlikely. Spontaneous resolution of these hydrothoraces has been reported (43).…”

Section: Treatmen Tmentioning

confidence: 98%

“…These procedures seek to encourage spontaneous closure of the pleuroperitoneal communication by eliminating the pressure gradient between the two cavities. Some have suggested that the dialysate itself could act as a sclerosant by promoting a "waterproof seal" of the epithelial layers (12,43). In spite of occasional spontaneous resolutions, cure rates are about 40% (49) and recurrences are common.…”

Section: Treatmen Tmentioning

confidence: 99%