Peritoneal Dialysis

Epidemiology

  • Acute pleural effusion may occur in some cases
  • Incidence: 10% of CAPD patients will develop effusion
  • Most cases occur within 4 months of beginning CAPD (one case occurred 10 months later)

Physiology

  • Movement of dialysate through diaphragm into pleural space

Diagnosis

  • Pleural fluid:
    -Appearance:
    -pH:
    -LDH ratio: low pleural LDH
    -Total protein ratio: pleural protein <10g/L
    -Glucose: intermediate between that of dialysate and serum
    -Cell count/ diff:

CXR/Chest CT patterns:
1) Pleural effusion:


Clinical

  • Pleural Effusion (see [[Pleural Effusion-Transudate]]

Treatment

  • Closure of diaphragmatic defect:
    • Spontaneous closure: occurs in some cases
    • Surgical closure: may be required required in some cases if CAPD is to be continued
    • Pleurodesis (treatment of choice): pleurodesis, followed by a short period of small-volume intermittent peritoneal dialysis

References

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