Pleural Complications in Patients With Chronic and End-Stage Renal Disease

Objective:To find out the clinical presentation, causes and outcomes of pl. complications in CKD and ESRD patients receiving haemodialysis. Materials and methods: One hundred thirty patients with CKD and ESRD, were included in this study. The following were analysed: Patients data, causes, location, CBC, ESR ,serum albumin, chest X ray and USG findings and pleural fluid analysis. Results: The incidence of pleural effusions in patients with CKD and ESRD was 80.8%, followed by Pyopneumothorax then Pneumothorax. Most common cause of PE was found to be parapneumonic effusion, followed by hypervolaemiaand uraemic pleurisy. Patients with parapneumonic effusions (p=0.0006), uremic,and tuberculosis (p=0.003),were more likely to have unilateral PEs than patients with hypervolaemia & heart failure. Shortness of breath, cough, fever and chest pain are the most common symptoms . Pl. fluid analysis showed that Pl. to serum protein ratio, polymorphonuclear (%) were significantly higher in patients with parapneumonic eff. compared to patients with other causes of eff., whereas Lymphocytes (%) was significantly higher in patients with other causes of eff. Empyema culture were positive in 16 patients, Aerobic G. Norganisms, esp. K.pneumoniae , were the predominant pathogens in 11 patients ,aerobic G. P organisms, especially S. aureus, in 5 patients. Improvement was achieved in 87.7% of patients with pl. complications by continuation of HD, antibiotics, diuretics, antiTB drugs and chest tube. Conclusion: Pleural eff. the most common pl. complications followed by pyopneumothorax in patients with CKD & ESRD. Themost common cause of unilateral pl. eff. is parapneumonic eff. while in bilateral pl. eff. is hypervolaemia.