Krishnan RG et al. (2007) Acute hydrothorax complicating peritoneal dialysis. Perit Dial Int 27: 296–299

Acute hydrothorax affects 2–4% of peritoneal dialysis patients. Krishnan et al. have reviewed instances of this complication in 416 children (327 with acute renal failure and 89 with end-stage renal failure) who underwent automated in-unit peritoneal dialysis during the 20-year period from June 1985.

Early in the study period, patients with acute renal failure had catheters placed percutaneously and received 40 ml/kg cycles immediately after placement. The catheters of early enrollees with end-stage renal failure, and those of all patients who joined the study at a later stage, were placed surgically; dialysis fluid volumes in these two groups were increased gradually from 10 ml/kg to 40 ml/kg over 6 days.

Overall, 163 patients started on 40 ml/kg cycles and 253 received the graduated regimen. Acute hydrothoraces developed in 13 children, all of whom had started on 40 ml/kg cycles. Although 11 of 13 children with hydrothoraces had diarrhea-positive hemolytic–uremic syndrome, hydrothorax did not occur in any of the 138 children with this syndrome who had received graduated fills.

In 10 of 12 children aged ≥1 year who developed hydrothoraces, peritoneal dialysis was continued at half-volume with the patient sitting upright; these changes resulted in complete resolution of the hydrothorax over a few days. In six of these patients, cycle volume was increased to 40 ml/kg without recurrence of hydrothorax; the renal function of the other four children was restored while they were receiving reduced volumes. Two patients were switched to hemodialysis, and one preterm baby died.

The authors conclude that, outside the neonatal period, development of hydrothorax does not necessitate discontinuation of peritoneal dialysis.