ACUTE HYDROTHORAX COMPLICATING PERITONEAL DIALYSIS

• Published in: Peritoneal dialysis international Vol. 27; no. 3; pp. 296 - 299
• Main Authors: Krishnan, Rajesh G, Ognjanovic, Milos V, Crosier, Jean, Coulthard, Malcolm G
• Format: Journal Article
• Language: English
• Published: Milton, ON Multimed 01.05.2007
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; Hydrothorax - etiology; Infant; Infant, Newborn; Intensive care medicine; Male; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Peritoneal Dialysis - adverse effects; Renal failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Kidney disease; Extrarenal dialysis; Urinary system disease; Hydrothorax; Effusion; Respiratory disease; Renal failure; Pleural disease; Peritoneal dialysis
• ISSN: 0896-8608; 1718-4304
• DOI: 10.1177/089686080702700315

Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, United Kingdom Correspondence to: M.G. Coulthard, Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, NE1 4LP United Kingdom. malcolm.coulthard{at}nuth.nhs.uk 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. KEY WORDS: KEY WORDS:; Hydrothorax; renal failure. Received 31 May 2006; accepted 5 February 2007.