Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end‐stage renal disease: Insights and pathophysiology

Abstract

A rising prevalence of end-stage renal disease (ESRD) has led to a rise in ESRD-related pericardial syndromes, calling for a better understanding of its pathophysiology, diagnoses, and management. Uremic pericarditis, the most common manifestation of uremic pericardial disease, is a contemporary problem that calls for intensive hemodialysis, anti-inflammatories, and often, drainage of large inflammatory pericardial effusions. Likewise, asymptomatic pericardial effusions can become large and impact the hemodynamics of patients on chronic hemodialysis.Constrictive pericarditis is also well documented in this population, ultimately resulting in pericardiectomy for definitive treatment. The management of pericardial diseases in ESRD patients involves internists, cardiologists, and nephrologists. Current guidelines lack clarity with respect to the management of pericardial processes in the ESRD population. Our review aims to describe the etiology, classification, clinical manifestations, diagnostic imaging tools, and treatment options of pericardial diseases in this population.

Anaesthesia for Patients with Pericardial Disease

“…Causes of pericardial effusion are similar to those for pericarditis and may be due to the inflammatory process itself [6,16,[18][19][20][21]. The most common causes of pericardial effusion seen in the peri-operative period are iatrogenic, associated with cardiac surgery or percutaneous coronary intervention (PCI); traumatic as seen in blunt or penetrating chest injuries; associated with malignancy; as a consequence of end-stage renal disease or dialysis; and those occurring from infectious diseases.…”

“…Patients with end-stage renal disease (ESRD) frequently present to the anaesthesiologist for a number of diagnostic, therapeutic or vascular access procedures [6,[18][19][20][21]. The association with end-stage renal and cardiovascular disease is well established.…”

“…Increased inflammatory processes, immune and autoimmune dysfunction, dyslipidaemia, endocrine abnormalities, oxidative stress and accumulation of toxic metabolites have all been suggested as causes for this association. This population is known to have an increased incidence of coronary artery disease, valvular pathology, arrhythmias and myocardial and pericardial diseases [18].…”

“…Patients on haemodialysis develop dialysis pericarditis with effusions that more frequently require drainage via a pericardial window procedure. This group of patients has a higher incidence of progressing to constrictive pericarditis possibly requiring pericardiectomy [18]. Progression from effusion to tamponade may be difficult to diagnose, but progressive right heart failure and hypotension in the setting of adequate diuresis is highly suggestive [18].…”

“…This group of patients has a higher incidence of progressing to constrictive pericarditis possibly requiring pericardiectomy [18]. Progression from effusion to tamponade may be difficult to diagnose, but progressive right heart failure and hypotension in the setting of adequate diuresis is highly suggestive [18]. All patients with ESRD presenting for surgery should have pre-operative investigations to rule out significant pericardial disease that may impact on peri-operative management.…”