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Published on: July 19, 2018
Acute hydrothorax complicating peritoneal dialysis
Rajesh G Krishnan1, Milos V Ognjanovic, Jean Crosier
1Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, United Kingdom.
Insights
Gradually increasing peritoneal dialysis fluid volume prevents hydrothorax in children. This method is safer than starting with a large volume, reducing complications and allowing continued dialysis.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Hydrothorax is a known complication of peritoneal dialysis in children.
- The optimal method for initiating peritoneal dialysis fill volumes to prevent hydrothorax is not well-established.
Purpose of the Study:
- To evaluate if a gradual increase in peritoneal dialysate fill volume prevents hydrothorax in pediatric patients.
- To assess if this approach can also manage existing hydrothorax.
Main Methods:
- Retrospective review of children undergoing peritoneal dialysis over 20 years.
- Comparison of outcomes between children with gradually increasing fill volumes versus those starting at a high fill volume (40 mL/kg).
Main Results:
- None of the 253 children with gradually increasing fill volumes developed hydrothorax.
- 8% of 163 children starting with 40 mL/kg fill volumes developed hydrothorax (p < 0.000).
- Hydrothorax cases were predominantly right-sided and diagnosed within 48-72 hours.
Conclusions:
- Graduated peritoneal dialysate fill volumes effectively prevent acute hydrothorax in children.
- This approach allows for the continuation of peritoneal dialysis even in cases where hydrothorax develops, and is not a contraindication.
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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