Pericardial effusions in patients with end-stage renal disease

Echocardiography has greatly increased the accurate recognition of pericardial effusion. Echocardiograms were performed prospectively on the total group of 35 stable asymptomatic patients on chronic haemodialysis to determine the incidence of pericardial effusion. Effusions were shown in 11 per cent (4/35); only 6 per cent (2/35) were estimated as greater than 100 ml. For comparison, records were reviewed retrospectively from 41 haemodialysis patients referred during a 27-month period for echocardiographic assessment of suspected pericardial effusion. These 41 patients came from a total group of 108 patients treated with chronic dialysis over this interval. Of 41 examined, 21 (51%) or 21 of 108 (19%) of the population at risk had an effusion. Of 21 with echocardiographic effusions, 15 (71%), or 15 of 41 (37%) of those with clinically suspected effusion, had more than 100 ml fluid. Gross (greater than 100 ml) pericardial effusions are infrequent in stable, asymptomatic patients with end-stage renal disease. When clinical findings suggest pericardial disease, the echocardiographic demonstration of over 100 ml pericardial fluid is indicative of new effusion, rather than coincidental pre-existing effusion.