[Surgical Treatment Strategy for Pyothorax in Maintenance Hemodialysis Patients]

Patients on dialysis with end-stage renal failure often develop pleural effusion, which is typically managed by dehydration. However, distinguishing empyema from pleural effusion is crucial, since empyema may not present with typical symptoms like fever, leading to potential misdiagnosis. This study examines the surgical treatment of empyema in dialysis patients. Between 2021 and 2024, among 404 dialysis patients, 5(1.2%)developed empyema. The patients(4 males, 1 female)had a mean age of 69.8 years, and all had diabetic nephropathy-induced renal failure. Two patients presented with asymptomatic pleural effusion, while three patients had fever and leukocytosis. Two patients had encapsulated effusions requiring early surgery. Surgery was performed in four cases after antibiotic treatment, while one received drainage and antibiotics alone. All underwent thoracoscopic procedures, with one patient requiring fenestration for recurrent multidrug-resistant empyema.