Abstract: FR-PO469
Pleuroperitoneal Leak in Peritoneal Dialysis: A Case Series
Session Information
- Peritoneal Dialysis: Current Topics
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Ávila, Gonçalo, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
- Matias, Patrícia, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
- Calça, Rita, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
- Branco, Patricia Quadros, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
Background
Pleuroperitoneal leak (PPL) is a rare cause of pleural effusion in peritoneal dialysis (PD) patients due to congenital or aquired defects in the diaphragm muscle fibers or connective tissue. In the first case, it manifests on the first days after beginning PD. The latter situation may present months or years after and is associated with excessive intra-abdominal pressure. Peritoneal scintigraphy with Tc-99m macroaggregated albumin (MAA) injected into the abdominal dialysate port is a useful diagnostic test with good sensitivity.
The aim of this study was to describe the characteristics and outcomes of a group of PD patients with diagnosed PPL.
Methods
We conducted a single center, retrospective study, that included patients on PD with confirmed PPL from 2011 to 2022. Demographic and clinical parameters were obtained. Patients were followed since the beginning of PD until technique dropout.
Results
Ten patients with PPL were included, with mean age of 56.5 ± 11.3, and 70% females. Mean body mass index was 26.9 ± 4.4 kg/m2. Median DP vintage at the time of diagnosis was 92 days (IQR 29.5 - 412.5). All cases were right-sided leaks. In three patients it developed in the first month, in four patients within 3 months and in three patients after one year. Only one patient had one episode of peritonitis before diagnosis.
The most common symptoms at the time of diagnosis were cough (50%) and pleuritic pain (40%). Diagnosis was made using peritoneal scintigraphy with MAA in 90% of patients. Seven patients underwent talc pleurodesis after a median time of 8 days after the diagnosis. In four patients, the pleural effusion recurred in the period of approximately one month after restarting PD. The median technique survival of patients in whom the procedure was effective was 12 months.
Conclusion
PPL are a rare cause of pleural effusion in PD patients that carry important morbidity, requiring immediate switching to another renal replacement therapy and requiring an invasive procedure for its treatment, which has a limited efficacy (42% in our cohort). There is currently no standardized method for its diagnosis. In this study, peritoneal scintigraphy with MAA demonstrated to be a safe, noninvasive, and cost-effective exam. Patients presenting with new onset right sided pleural effusion, particularly in the first weeks or months after beginning PD, should be investigated for PPL.