Changing patterns of pericardial disease in patients with end-stage renal disease

Pericarditis can occur in patients with chronic renal failure before initiation of dialysis. It is also described in established dialysis patients. Traditionally, the cause of pericarditis in such settings has been attributed to uremia and/or inadequate dialysis and it is consequently thought that intensifying the dialysis process in such patients could improve outcome. We report here 7 cases of acute pericarditis in patients with end-stage renal disease on renal replacement therapy. Only 3 of the patients gave any history of chest pain, and a pericardial friction rub was only noted in 2. Despite a period of intensive dialysis, none of the patients improved and all required pericardial drainage as the definitive curative procedure. The clinical presentation of acute pericarditis in dialysis patients therefore may be atypical and pericardial drainage should be considered early, as intensive dialysis alone may not lead to resolution.