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Abstract: FR-PO400

Pericardial Effusions in Patients with Renal Disease: A Single-Centre Experience

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Author

  • Thind, Amarpreet Kaur, West London Renal and Transplant Centre, Hounslow, United Kingdom
Background

Pericardial effusions are common in renal patients and frequently thought to be uraemia related. However alternative aetiologies do exist and the best management approach remains unclear.

Methods

All renal inpatients with pericardial effusions at a tertiary renal centre from 2010-2018 were identified, and data was collected on patient factors, investigation results, treatment, interventions, and outcomes. This was used to compare cases undergoing pericardiocentesis versus those that did not, identify causes of pericardial effusion and create diagnostic groups for comparison.

Results

Fourty-six patients with pericardial effusions were identified, aged 18-83, 63% male. Renal modalities included haemodialysis (72%), peritoneal dialysis (9%), CKD (6%), transplant (6%), and AKI requiring renal replacement therapy (RRT) (7%). Twenty-four patients underwent pericardiocentesis. The commonest reason for this was cardiovascular compromise, with 21/24 cases having a large effusion (>2cm) on imaging. The commonest cause of pericardial effusion was uraemia related (15), followed by idiopathic/incidental (10), surgical (7), tuberculosis (Tb) related (6), autoimmune (4), pyogenic (3) and unknown (1). Pericardial fluid microbiology culture was positive in only 3 cases, and no positive Tb cultures were obtained. Of the drained cases 13 had fluid protein levels measured; in all cases the protein level was >35g/L. Fluid LDH was measured in 15 patients; in 11 cases this was >2/3 the upper reference range.

Conclusion

In our cohort uraemic pericardial effusions were the commonest cause, in keeping with previous studies. This uraemic group included patient’s pre-RRT initiation, RRT non-compliant patients, and patients switching modality, suggesting that poor dialysis contributed to effusion development. Other aetiologies did exist and so a wide differential must be maintained. Pericardiocentesis was only necessary for therapeutic relief, as drainage did not aid diagnosis, therefore it should be reserved for cases with clinical compromise. Although fluid LDH and protein levels in our cohort suggested mostly exudative effusions, current literature states that these factors do not reliably distinguish between pericardial effusion types nor help in establishing the cause. Our findings have revealed diagnostic groups that will be further analysed to help identify differentiating factors between these effusions.