Acute hydrothorax complicating peritoneal 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.