Hydrothorax as a Complication of Pediatric Peritoneal Dialysis

Abstract

Hydrothorax is a known complication of peritoneal dialysis (PD) but there is very little in the pediatric literature concerning this complication. From 1982 to 1984 seven of 29 of our patients who underwent peritoneal dialysis, developed pleural effusions as a complication of PD. These patients varied in respect to age, technique and duration of PD. Four of the seven developed respiratory symptoms at the time when effusions were discovered, while the other three were recognized during evaluation of loss of ultrafiltration. Five of the seven had right-sided effusions, one had a left-sided effusion, and one had bilateral effusions. No technical factors could be identified as causative agents. We have concluded that pediatric patients may be particularly likely to develop hydrothorax as a complication of peritoneal dialysis. This may present as a pulmonary emergency or as a subtle loss of ultrafiltration ability. The possibility of congenital potential communicating pathways seems more likely than any other single explanation for this phenomena. Hydrothorax as a complication of peritoneal dialysis (PD) is reported chiefly in the adult PD literature. The first reports were associated with trauma but in most subsequent cases, there was no explanation. We are aware of only two accounts of this complication in children covering a total of eight cases. Several of these may have been related to surgical trauma (1). However, in our own patient population, we observed seven who developed hydrothorax while on various forms of PD. Review of individual cases did not demonstrate common factors which would explain the hydrothorax. Thus, hydrothorax developed during PD in a significant number of infants over a short period and under a variety of clinical circumstances. This suggests the existence of potential anatomical channels which may open under a variety of circumstances.