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Kidney Week

Abstract: PO1004

Sweet Pleural Effusion in a Peritoneal Dialysis Patient

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Carias Martinez, Karla G., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Srialluri, Nityasree, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Monroy-Trujillo, Jose Manuel, Johns Hopkins University, Baltimore, Maryland, United States
Introduction

Pleural Effusions are frequently seen in dialysis patients with an incidence as high as 80%, with a variety of possible differential etiologies

Case Description

A 62-year-old female with HFpEF, DM and ESRD due to biopsy proven diabetic nephropathy recently started on nightly continuous cyclic PD with a prescription of 4 exchanges of 2.5% Dextrose solution with 2 liters fill volumes with a dwell time of 1h40 min for a total time of 8.5 hrs with no day dwells presented with dyspnea. She had missed 2 sessions of dialysis and noted increasing weight as declining ultrafiltration volumes. On exam tachypneic on 4L of oxygen and saturating 100% , had decreased breath sounds on the right pulmonary base, no JVD or lower extremity edema. Laboratory showed creatinine 4.19 mg/dl, BUN 41 mg/dl, proBNP 30,186 pg/ml, Hemoglobin 11 gm/dl and WBC 5.91 mg/dl. Chest X- Ray revealed small to moderate right pleural effusion and opacities in the right mid and lower lung. CT Chest showed a large right sided pleural effusion. With her unilateral pleural effusion and recent start of PD the presence of a peritoneal pleural fistula was suspected. A therapeutic thoracentesis was done draining 1 liter of fluid consistent with a transudate, no microorganism or malignant cells were isolated. Pleural fluid glucose was 274 mg/dL compared to a serum glucose of 155 mg/dL. A peritoneal perfusion scan was done detecting radiotracer uptake in right hemithorax Image 1 confirming a peritoneal pleural communication. She was transitioned to HD and maintained on it per the patient's preference

Discussion

A pleuroperitoneal leak is a rare but important cause of pleural effusion in patients on PD and should be considered in any patient presenting with a unilateral effusion. Incidence is less than 2%. The diagnosis is made by measuring the ratio between the pleural to serum glucose which usually is > 1 . Other tests include technetium-99m labeled peritoneal scintigraphy. Treatment usually requires cessation of PD for 4-6 weeks and transition to HD. For patients willing to return to PD, a diaphragmatic repair is usually required

Image 1