Diagnostic and therapeutic management of hydrothorax in peritoneal dialysis

Strasbourg experience in 11 cases.

Keywords: Hydrothorax, peritoneal dialysis, surgical repair, pleurodesis, pleuroperitoneal communication

Abstract

Hydrothorax is a rare mechanical complication of peritoneal dialysis (PD) which often results in discontinuation of the technique. According to studies, its incidence is estimated  at 1.6 to 2%. In the majority of cases, its location is on the right. It is secondary to the passage of dialysate from the peritoneal cavity to the pleural space through a diaphragmatic breach, which may be acquired or congenital. The additional tests necessary to confirm the diagnosis are often invasive and expensive, and are not the subject of any consensus. It is the same for the therapeutic management, which goes from the simple transient interruption of the dialysis to heavy treatments such as thoracotomy. In our center, we have opted to simplify the management of patients with hydrothorax. From a diagnostic standpoint, we use simple, minimally invasive and less expensive examinations. For the therapeutic management, we have opted, since our first case in 2000, for a simple and less aggressive surgical technique, with an abdominal and non-thoracic approach allowing the installation of a sub-diaphragmatic prosthesis by laparoscopic route to seal the lesions breaches. Out of 10 operated patients, 2 (20%) presented with a relapse of hydrothorax and were permanently transferred to hemodialysis. The remaining 8 (80%) were able to resume PD without subsequent recurrence or complications, after a 3- to 4-week PD interruption period during which all patients were hemodialyzed through a simple central catheter.

 

References

Nomoto Y, Suga T, Nakajima K, Sakai H, Osawa G, Ota K. Acute hydrothorax in continuous ambulatory peritoneal dialysis – a collaborative study of 161 centers. Am J Nephrol. 1989;9:363–367. [PubMed] [Google Scholar]

Edward SR, Unger AM. Acute hydrothorax: a new complication of peritoneal dialysis. JAMA. 1967;199:853–855. [PubMed] [Google Scholar]

Szeto, C.C. , Chow, K.M. Pathogenesis and management of hydrothorax complicating Peritonealdialysis. CurrOpinPulmMed2004;10: 315–19. [GoogleScholar] |Crossref | [Medline]

Momenin N, Colletti PM, Kaptein EM. Low pleural fluid-to-serum glucose gradient indicates pleuroperitoneal communication in peritoneal dialysis patients: presentation of two cases and review of the literature. Nephrol Dial Transplant 2012; 27: 1212–1219 [PubMed] [Google Scholar]

Camilleri B, Glancey G, Pledger D, et al. The icodextrin black line sign to confirm a pleural leak in a patient on peritoneal dialysis. Perit Dial Int 2004; 24: 197. [PubMed] [Google Schola]

Huang, J.J. , Wu, J.S. , Chi, W.C. , Lan, R.R. , Yang, L.F. , Chiu, N.T. Hydrothorax in continuous ambulatory peritoneal dialysis: therapeutic implications of Tc-99m MAA peritonealscintigraphy. NephrolDialTransplant 1999;14: 992–7.

[Google Scholar | Crossref | Medline]

Pankaj P, Pathak V, Sen IB, Verma R, Bhalla AK, Marwaha A, Pandey S. Use of radionuclide peritoneography in the diagnosis of pleuroperitoneal communication as a complication of continuous ambulatory peritoneal dialysis. Ind J Nucl Med. 2005;20:4–8. [Google Scholar]

Tang S, Chui WH, Tang AW, Li FK, Chau WS, Ho YW, Chan TM, Lai KN. Video-assisted thoracoscopic talc pleurodesis in effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis. Nephrol Dial Transplant. 2003;18:804–808. [PubMed] [Google Scholar]

M. Macia, E. Gallego, I. Garcia-Cobaleda, J. Chahin, and

J. Garcia, “Methylene blue as a cause of chemical peritonitis in

a patient on peritoneal dialysis,” Clinical Nephrology, vol. 43,

no. 2, pp. 136-137, 1995

Jun Young Lee, Jae-Won Yang, Seung Ok Choi, Byoung- Geun Han. Utility of indocyanine green for diagnosing peritoneal dialysis related hydrothorax. Kidney Research and Clinical Practice 2018;37(4):423

Jannis Vlachojannis, Ivar Boettcher, Lothar Brandt, Wilhelm Schoeppe. A new Treatment for Unilateral Recurrent Hydrothorax during CAPD, Peritoneal Dialysis International, vol. 5, 3: pp. 180-181. 1985

Chow KM, Szeto CC, Li PKT. Options de gestion de l'hydrothorax compliquant l'analyse péritonéale. Séminaire Dial. 2003; 16: 389–94.

Saito M, Nakagawa T, Tokunaga Y, Kondo T.Traitement chirurgical thoracoscopique pour la communication pleuropéritonéale. Intéragir Cardiovasc Thorac Surg. 2012; 15: 788–9

DidierMutter, Cosimo Callari, Michele Diana, Larbi Bencheikh, Françoise Heibel, Jacques Marescaux. A Novel Technique to Treat hydrothorax in Peritoneal Dialysis: Laparoscopic Hepato-diaphragmatic Adhesion. Perit Dial Int Nov-Dec 2011;31(6):692-4

G. Del Peso, M.A. Bajo, O. Costero, C. Hevia, F. Gil, C. Díaz, et al.

Risk factors for abdominal wall complications in peritoneal dialysis patients.

Perit Dial Int, 23 (2003), pp. 249-254

Emerson, FA, Davies, TH Hydrothorax compliquant l'ascite. Lancet 1995 ; 1: 487 . [Google Scholar]

Lieberman, F. , Hidemura, R. , Peters, R. , Reynolds,T. Pathogenesis and treatment of hydrothorax complicating cirrhosis with ascites. Ann Int Med 1966; 64: 341–51.

[Google Scholar | Crossref | Medline]

Fletcher, S. , Turney, J.H. , Brownjohn, A.M. Increased incidence of hydrothorax complicating peritoneal dialysis in patients with adult polycystic kidney disease. Nephrol Dial Transplant 1994; 9: 832–3. [Google Scholar]| Medline]

Krishnan, R.G. , Ognjanovic, M.V. , Crosier, J. , Coulthard, M.G. Acute hydrothorax complicating peritoneal dialysis. Perit Dial Int 2007;27: 296–9.[Google Scholar | SAGE Journal]

Butani, L. , Polinsky, M.S. , Kaiser, B.A. , Baluarte, H.J. Pleural effusion complicating acute peritoneal dialysis in hemolytic uremic syndrome. Pediatr Nephrol 1998; 12: 772–4.

[Google Scholar | Crossref | Medline]

Mehrotra, R. , Chiu, Y.W. , Kalantar–Zadeh, K. , Bargman, J. , Vonesh, E. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 2011; 171: 110–18. [ Google Scholar | Crossref | Medline]

R. Garcia Ramon and A. Miguel Carrasco, “Hydrothorax in peritoneal dialysis,” Peritoneal Dialysis International, vol. 18, no. 1, pp. 5–10, 1998.View at: [Google Scholar]

Nada Kanaan, Thierry Pieters, Francois Jamar, Eric Goffin Hydrothorax complicating continuous ambulatory peritoneal dialysis: successful management with talc pleurodesis under thorcoscopy. Nephrol Dial Transplant (1999) 14: 1590-1592

Published
2021-05-20
How to Cite
1.
Bencheikh L, D’Urso A, Heibel F. Diagnostic and therapeutic management of hydrothorax in peritoneal dialysis. Bull Dial Domic [Internet]. 2021May20 [cited 2022Jun.30];4(2):95-103. Available from: https://www.bdd.rdplf.org/index.php/bdd/article/view/61603