Diagnostic value of pericardial aspiration in dialysis patients: Case report with management informed by a retrospective case series.

ABSTRACT

INTRODUCTION: Pericardial effusions and uremic pericarditis have been described in patients with kidney disease since 1836 [1] when they were considered a pre-terminal sign [2]. Fortunately today this pathology is less frequently encountered [3]; however, this has resulted in highly variable management. AIMS: This report aims to describe the case of a 61-year-old female presenting with a large pericardial effusion prior to kidney transplantation, and how local activity was reviewed to guide management. MATERIALS AND METHODS: We performed a retrospective service evaluation project, where 44 cases of pericardial effusion encountered at a tertiary renal center over 8 years were reviewed. Clinical data, investigation results, and outcomes were collected to identify the common clinical categories encountered and the role pericardial intervention may have had in those cases. RESULTS: A total of 44 cases of pericardial effusion were encountered, grouped into the following clinical categories; procedural (8), classical (3), uremic (15), and other etiology (18). Pericardial intervention occurred in 50% of cases due to current or impending hemodynamic compromise. Aspiration was of limited diagnostic use, providing a clinically relevant culture result in only one of the cases reviewed. No deaths were observed in the classical group, and 1-year survival was 86%, 67% and 43% in the uremic, other, and procedural groups, respectively. CONCLUSION: Our findings suggest that in patients with advanced kidney disease requiring renal replacement therapy and pericardial effusions, aspiration should largely be reserved for cases with hemodynamic compromise only, as in this series aspiration did not significantly improve diagnosis or guide subsequent treatment.