Pericarditis in the patient with uremia: clinical and echocardiographic evaluation

Over a 4-year period, 94 of 248 patients with end-stage renal disease were evaluated echocardiographically because of clinically suspected pericarditis. The clinical diagnosis was established in 39 patients based on the development of a friction rub at some time during their course. 15 of the 55 patients, in whom the diagnosis of pericarditis could not be established, had a small pericardial effusion. The rest had no pericardial fluid. 15 patients developed pericarditis prior to the initiation of dialysis and all responded to dialysis alone. 4 had no effusions, 3 had small effusions and 8 had moderate or large effusions. In 9 of 24 dialysis patients with pericarditis, a presumptive etiology other than uremia was identified. In these 24 patients, 9 had no effusions, 2 had small effusion and 13 had moderate or large effusions. Only 9 patients, all with moderate or large effusions, required operation. The data suggest that: t1) pericarditis present at the initiation of dialysis regularly resolves with dialysis; (2) specific etiologies are common; (3) small pericardial effusions are common in dialysis patients without pericarditis; (4) pericardial effusions are frequently not present in uremic patients with pericarditis and, (5) the size of the pericardial effusion is of some value in predicting which patients may subsequently require operative intervention.