Pericarditis in patients undergoing long-term hemodialysis and peritoneal dialysis: Incidence, complications and management

Abstract

A retrospective review of 99 patients undergoing long-term hemodialysis and 119 patients undergoing long-term peritoneal dialysis between 1966 and 1974 revealed 43 episodes of pericarditis in 43 patients, an over-all incidence of 20 per cent. In 27 of the total 218 patients (12.4 per cent) pericarditis developed prior to or within two months of starting dialysis. In 12 of 99 patients (12.1 per cent) pericarditis developed after they had been undergoing hemodialysis for more than four months, whereas in only four of 119 patients (3.4 per cent) did pericarditis develop after they had been subjected to peritoneal dialysis for more than four months; this difference did not reach statistical significance. There was no significant difference between mean blood urea nitrogen and serum creatinine levels in patients with or without pericarditis. Patients with pericarditis had significantly higher reticulocyte counts (p <.001) than those without pericarditis. Cardiac tamponade developed in six patients (2.8 per cent of the total population or 14 per cent of those in whom pericarditis developed), none of whom was undergoing peritoneal dialysis. Twenty-one needle pericardiocenteses were performed in five patients with cardiac tamponade and 10 patients with pericardial effusion without cardiac tamponade. There was no procedure-associated mortality. Pericardial surgery was performed in only one patient. Only two patients died of causes directly related to their pericarditis. On the basis of this study we advocate pericardial surgery only for the rare occasions of recurrent cardiac tamponade. We recommend needle pericardiocenteses for the initial treatment of pericardial effusion without tamponade or as a diagnostic procedure. In pericardial effusion without tamponade the pericarditis can be expected to resolve with conservative management.