Massive hydrothorax complicating continuous ambulatory peritoneal dialysis

Area of Science:

• Nephrology
• Pulmonology
• Critical Care Medicine

Background:

• Continuous ambulatory peritoneal dialysis (CAPD) is a common renal replacement therapy.
• Hydrothorax, the accumulation of fluid in the pleural space, is a rare but serious complication of CAPD.
• Understanding the mechanisms of CAPD-induced hydrothorax is crucial for patient management.

Observation:

• Two patients undergoing CAPD presented with massive hydrothorax.
• Diagnostic investigations ruled out a direct pleuroperitoneal communication.
• Fluid transfer from the peritoneal cavity to the pleural space was identified as the likely cause.

Findings:

• Hydrothorax resolved in both patients after a temporary cessation of CAPD.
• One patient experienced a recurrence of hydrothorax upon resuming CAPD.
• This suggests a direct relationship between CAPD and hydrothorax development.

Implications:

• Patients experiencing hydrothorax during CAPD require careful monitoring and management.
• Recurrent cases may necessitate discontinuation of CAPD.
• Alternative dialysis modalities or procedures like pleurodesis should be considered for persistent or recurrent hydrothorax.