Pleural effusions in hospitalized patients receiving long-term hemodialysis

To determine the incidence, causes, and clinical features of pleural effusions in hospitalized patients receiving long-term hemodialysis.

Retrospective.

One hundred patients receiving hemodialysis for at least 3 months with pleural effusion hospitalized at the Medical University of South Carolina hospitals.

The incidence of pleural effusions in hospitalized patients receiving long-term hemodialysis was 21%. The mean (+/- SEM) age was 55 +/- 1.4 years and the male to female and black to white ratios were 3:2. Pleural effusions resulted from heart failure in 46% and nonheart failure causes in 54%. Uremic pleurisy (n = 16), parapneumonic effusion (n = 15), and atelectasis (n = 11) accounted for most of the nonheart failure causes of pleural effusions. Three of 15 (20%) parapneumonic effusions were empyemas. The presence of chest pain was not different in patients with parapneumonic effusions than in other patients with nonheart failure effusion (all p = NS) but was more frequent compared to those with heart failure (p = 0.006). Patients with parapneumonic effusions (p = 0.0006) and atelectasis (p = 0.003) were more likely to have unilateral pleural effusions than patients with heart failure.

Pleural effusions are common in hospitalized patients receiving chronic hemodialysis. Although heart failure was the most common cause, other diseases were responsible for most of the effusions. The presence of a unilateral effusion suggests a diagnosis other than heart failure, most commonly parapneumonic effusion or atelectasis and deserves prompt thoracentesis as these effusions often cannot be reliably differentiated clinically. The reduced humoral and cellular immunity, in addition to delay in diagnosis because of an attenuated clinical response, may explain the high rate of empyemas in this study population.