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)

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Physiology

• Movement of dialysate through diaphragm into pleural space

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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:

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Clinical

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

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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

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References

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