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Bencheikh L, D'Urso A, Heibel F. Diagnostic and therapeutic management of hydrothorax in peritoneal dialysis. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i2.61603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hydrothorax is a rare mechanical complication of peritoneal dialysis (PD) which often results in discontinuation of the technique. According to studies, its incidence is estimated at 1.6 to 2%. In the majority of cases, its location is on the right. It is secondary to the passage of dialysate from the peritoneal cavity to the pleural space through a diaphragmatic breach, which may be acquired or congenital. The additional tests necessary to confirm the diagnosis are often invasive and expensive, and are not the subject of any consensus. It is the same for the therapeutic management, which goes from the simple transient interruption of the dialysis to heavy treatments such as thoracotomy. In our center, we have opted to simplify the management of patients with hydrothorax. From a diagnostic standpoint, we use simple, minimally invasive and less expensive examinations. For the therapeutic management, we have opted, since our first case in 2000, for a simple and less aggressive surgical technique, with an abdominal and non-thoracic approach allowing the installation of a sub-diaphragmatic prosthesis by laparoscopic route to seal the lesions breaches. Out of 10 operated patients, 2 (20%) presented with a relapse of hydrothorax and were permanently transferred to hemodialysis. The remaining 8 (80%) were able to resume PD without subsequent recurrence or complications, after a 3- to 4-week PD interruption period during which all patients were hemodialyzed through a simple central catheter.
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Chow KM, Szeto CC, Wong TYH, Li PKT. Hydrothorax Complicating Peritoneal Dialysis: Diagnostic Value of Glucose Concentration in Pleural Fluid Aspirate. Perit Dial Int 2020. [DOI: 10.1177/089686080202200416] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kai Ming Chow
- Division of Nephrology Department of Medicine & Therapeutics The Chinese University of Hong Kong Shatin, Hong Kong SAR, China
| | - Cheuk Chun Szeto
- Division of Nephrology Department of Medicine & Therapeutics The Chinese University of Hong Kong Shatin, Hong Kong SAR, China
| | - Teresa Yuk-Hwa Wong
- Division of Nephrology Department of Medicine & Therapeutics The Chinese University of Hong Kong Shatin, Hong Kong SAR, China
| | - Philip Kam-Tao Li
- Division of Nephrology Department of Medicine & Therapeutics The Chinese University of Hong Kong Shatin, Hong Kong SAR, China
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Van Dijk CM, Ledesma SG, Teitelbaum I. Patient Characteristics Associated with Defects of the Peritoneal Cavity Boundary. Perit Dial Int 2020. [DOI: 10.1177/089686080502500412] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Conflicting literature exist regarding the patient characteristics that may confer an increased risk for anatomic complications of the peritoneal cavity boundaries. Methods We collected data from 75 randomly selected units in the United States and Canada, representing a total of 1864 peritoneal dialysis (PD) patients. Results 200 of these patients experienced a total of 217 anatomic complications between July 2000 and June 2001; 16 patients had more than 1 complication. Hernias comprised 60.4% of all complications: 24.9% inguinal, 18.9% umbilical, 13.8% ventral, 2.3% femoral, and 0.5% intrathoracic. Other complications included pericatheter or subcutaneous leak (25.3%), hydrothorax (6.0%), and miscellaneous (8.3%). Peritoneal dialysis modalities in use at the time of complication were automated PD (52.3%), continuous ambulatory PD (38.6%), and nocturnal intermittent PD (9.1%). The overall incidence of hernias was 7%. Conclusions Logistic regression analysis found no association between hernias and age, body surface area, PD modality, volume of dialysate, time of largest dwell (day/upright vs night/recumbent), or type of catheter used. Cystic disease conferred a 2.5-fold increase in risk for anatomic complications ( p < 0.001); female gender conferred an 80% reduction in risk ( p < 0.0001), and Kt/V ≥2.0 conferred a 52% reduction in risk ( p < 0.05) for hernia.
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Affiliation(s)
- Claudia M.A. Van Dijk
- Division of Nephrology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA
| | - Steven G. Ledesma
- Division of Nephrology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA
| | - Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA
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Krishnan RG, Ognjanovic MV, Crosier J, Coulthard MG. Acute Hydrothorax Complicating Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080702700315] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim To determine whether gradually increasing the peritoneal dialysate fill volume from 10 to 40 mL/kg over 6 days, rather than commencing at 40 mL/kg, prevents hydrothorax in children and reverses it if present. Methods A review of children peritoneally dialyzed in a single center. Results During the 20 years beginning June 1985, 416 children were peritoneally dialyzed, of which 327 (79%) had acute and 89 had end-stage renal failure. Among 253 children who had gradually increasing fill volumes, none developed acute hydrothoraces, but 13/163 (8%) who began with 40 mL/kg cycles did ( p < 0.000, Fisher's exact test). These were diagnosed after a median (range) of 48 (6 – 72) hours and were predominantly right sided. Initially, we readily abandoned peritoneal dialysis; 2 were changed to hemodialysis. Subsequently, we found that peritoneal dialysis could be continued by using small volumes with the patients sitting up; cycle volumes were then gradually increased again. One pre-term baby died soon after developing an acute hydrothorax. One patient on chronic peritoneal dialysis developed an acute hydrothorax after forceful vomiting, but recovered after being dialyzed sitting up with low fills. Conclusion Acute hydrothorax can be prevented and treated using graduated cycle volumes, and is not a contraindication for peritoneal dialysis.
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Affiliation(s)
- Rajesh G. Krishnan
- Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Milos V. Ognjanovic
- Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Jean Crosier
- Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Malcolm G. Coulthard
- Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, United Kingdom
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Fang S, Wu Z, Wang Q, Peng X, Zhan T, Wu M. Thoracoscopic surgery for management of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis: A case report. Medicine (Baltimore) 2019; 98:e15391. [PMID: 31083167 PMCID: PMC6531203 DOI: 10.1097/md.0000000000015391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Pleuroperitoneal communication (PPC) has been reported to complicate continuous ambulatory peritoneal dialysis (CAPD). However, cases of patients in whom the results of the methylene blue dye test and peritoneopleural scintigraphy were negative and treatment was thoracoscopic surgery have been rarely reported. PATIENT CONCERNS A 58-year-old man with end-stage chronic renal failure who underwent CAPD presented with massive right-sided hydrothorax. The pleural fluid glucose level was high. Results of both the methylene blue dye test and peritoneopleural scintigraphy were negative. DIAGNOSIS The presence of end-stage chronic renal failure and diaphragm defects amenable to repair, which were identified during thoracoscopic surgery, indicated a definite diagnosis of PPC complicating CAPD. INTERVENTIONS AND OUTCOMES CAPD was performed twice after the defects were repaired during thoracoscopic surgery. There was no evidence that the repaired sites were leaking again, and the patient did not complain of any discomfort during the second CAPD. LESSON Although special methods such as the methylene blue dye test and peritoneopleural scintigraphy may not be useful in some cases, thoracoscopic surgery is still effective and reliable in diagnosing and repairing diaphragmatic defects.
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Affiliation(s)
- Shuai Fang
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Zixiang Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Qi Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Xuyang Peng
- Department of Thoracic Surgery, the People's Hospital of Lishui, Lishui, China
| | - Tianwei Zhan
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Ming Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
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Balaguer D, Abreu P, Mut T, Reyes M, Plancha M, Caballero E. Hidrotórax secundario a diálisis peritoneal detectado mediante gammagrafía peritoneal. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Balaguer D, Abreu P, Mut T, Reyes M, Plancha M, Caballero E. Hidrotórax secundario a diálisis peritoneal detectado mediante gammagrafía peritoneal. Rev Esp Med Nucl Imagen Mol 2018; 37:118-120. [DOI: 10.1016/j.remn.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 01/28/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
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You G, Shin HS, Jung YS, Rim H. A Case of Hydrothorax Aggravated by Peritoneal Dialysate Leakage in Compensated Liver Cirrhosis Patient with Ascites. KOSIN MEDICAL JOURNAL 2014. [DOI: 10.7180/kmj.2014.29.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The cirrhotic patients with ascites present unique challenge to the renal caregiver. Hydrothorax in a cirrhotic patient treated with PD poses a diagnostic dilemma. Proposed mechanisms for the development of a pleuroperitoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. We report a case of hydrothorax in a compensated cirrhotic patient after recent introduction to peritoneal dialysis.
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Chavannes M, Sharma AP, Singh RN, Reid RH, Filler G. Diagnosis by peritoneal scintigraphy of peritoneal dialysis-associated hydrothorax in an infant. Perit Dial Int 2014; 34:140-3. [PMID: 24525610 DOI: 10.3747/pdi.2012.00077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Chavannes
- Department of Pediatrics1 Department of Imaging2 Department of Medicine3 Department of Pathology and Laboratory Medicine4 Schulich School of Medicine and Dentistry London, Ontario, Canada
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Momenin N, Colletti PM, Kaptein EM. Low pleural fluid-to-serum glucose gradient indicates pleuroperitoneal communication in peritoneal dialysis patients: presentation of two cases and a review of the literature. Nephrol Dial Transplant 2011; 27:1212-9. [PMID: 21771760 DOI: 10.1093/ndt/gfr393] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transudative pleural effusions due to pleuroperitoneal communication occur in 1.6-10% of patients receiving peritoneal dialysis (PD) and usually have overtly elevated glucose concentrations. METHODS We report two cases of verified pleuroperitoneal communication with minimally elevated pleural fluid glucose levels. We reviewed the literature of all PD patients with pleuroperitoneal communication that reported pleural glucose levels to assess their clinical and laboratory features and pleural fluid-to-serum glucose gradients. RESULTS We evaluated a total of 47 reported patients on PD with diagnosed pleuroperitoneal communication. Onset of the transudative pleural effusion after initiating PD was <3 months in only 48%. Shortness of breath was reported in 96%. Pleural effusions were right sided in 87%. Pleural fluid-to-serum glucose gradients varied from 2 to 1885 mg/dL, with 20% ≤50 mg/dL, 13% being 51-100 and 67% >100 mg/dL. All pleural fluid-to-serum glucose ratios were >1. CONCLUSIONS With a transudative pleural effusion in patients receiving PD, a pleural fluid-to-serum glucose ratio >1 is consistent with a pleuroperitoneal communication. In questionable cases, independent verification is necessary.
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Affiliation(s)
- Nima Momenin
- Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Abstract
Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of PD but generally does not threaten life. Shortness of breath causes the patient to seek medical attention. A sudden diminution in dialysis adequacy or poor ultrafiltration rate constitutes a unique marker for patients treated with PD compared to the general population. This article reviews the etiology for hydrothorax specifically in the PD population. Thoracentesis with chemical analysis of the fluid, imaging studies with and without contrast or markers, and video-assisted thoracoscopic surgery play important roles in the evaluation of hydrothorax. A conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.
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Affiliation(s)
- Susie Q Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC 20037, USA.
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Laski ME. Opinion: What Unique Acid-Base Considerations Exist in Dialysis Patients? Semin Dial 2004. [DOI: 10.1111/j.0894-0959.2004.17345.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tang S, Chui WH, Tang AWC, Li FK, Chau WS, Ho YW, Chan TM, Lai KN. Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis. Nephrol Dial Transplant 2003; 18:804-8. [PMID: 12637652 DOI: 10.1093/ndt/gfg042] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute, massive, unilateral hydrothorax is an uncommon but well-recognized complication of peritoneal dialysis. Its clinical course and treatment outcome after a recently advocated technique of video-assisted thoracoscopic (VATS) talc pleurodesis remains unclear. METHODS AND RESULTS Between July 1998 and March 2002, among 475 CAPD patients in two regional hospitals in Hong Kong, nine patients (three men, six women, mean age 53+/-12 years) developed acute hydrothorax due to pleuroperitoneal communication (R=8, L=1) within 5.8+/-4.2 months (median, 5.2 m; range, 2 days to 11.6 months) of commencing peritoneal dialysis. Analysis of simultaneously obtained peritoneal and pleural fluid in all subjects only showed concordance in protein content (consistently<4 g/l), while fluid glucose and lactate dehydrogenase levels were not comparable. The methylene blue test was negative (n=4). Radionuclide scan (n=6) and contrast CT peritoneography (CTP, n=3) detected pleuroperitoneal communication in half and one-third of the patients, respectively. All patients underwent pleurodesis achieved by talc insufflation into the pleural cavity under VATS guidance. All patients were successfully returned to peritoneal dialysis. After a mean follow-up of 18.8+/-12.5 months, hydrothorax recurred in one patient (at 7 months after pleurodesis), who was successfully treated by repeating the procedure. CONCLUSIONS Hydrothorax complicating CAPD is more commonly right-sided, and tends to occur within the first year of starting peritoneal dialysis. Isotope scan and CTP are insensitive in diagnosing pleuroperitoneal communication. A low pleural fluid protein content is the most consistent biochemical finding. VATS talc pleurodesis is a safe and reliable treatment of choice that allows sustained continuation of CAPD with low recurrence rate.
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Affiliation(s)
- Sydney Tang
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, Peoples' Republic of China
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Contreras-Puertas P, Benítez-Sánchez M, Jiménez-Heffernan A, Rebollo-Aguirre A, Cruz-Muñoz S. Hydrothorax in continuous ambulatory peritoneal dialysis: peritoneoscintigraphy in a case of spontaneous closure of pleuroperitoneal communication. Clin Nucl Med 2002; 27:208-9. [PMID: 11852312 DOI: 10.1097/00003072-200203000-00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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