Unexplained Exudative Pleural Effusion in Chronic Peritoneal Dialysis Patients

Abstract

Although the clinico-pathological entity of uremic pleuritis has long been recognized, its clinical significance remains poorly defined. ♢ We retrospectively studied 82 chronic peritoneal dialysis (PD) patients that had pleural effusion. The pattern of diagnosis and clinical outcome were reviewed. ♢ 10 patients had overt fluid overload and thoracocentesis was not performed, 23 had other specific diagnoses, 15 had transudative effusion due to fluid overload, 12 had unexplained transudative effusion, and 22 patients had unexplained exudative effusion. The 3-year actuarial survival was 40.9% and 83.3% for patients with unexplained exudative and transudative effusion respectively (p = 0.012); technique survival was 74.2% and 90.9% respectively (p = 0.006). For patients with unexplained exudative effusion, 11 patients had their PD regimen intensified: they had a higher 3-year actuarial survival than those with their dialysis regimen unchanged (100.0% vs 52.6%, p = 0.04). ♢ Unexplained exudative pleural effusion is not uncommon in chronic PD patients. These patients have a high mortality; an intensive dialysis regimen may be considered.