Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Early Drainage of Pericardial Effusion in Patients With Dialysis Pericarditis

Early Drainage of Pericardial Effusion in Patients With Dialysis Pericarditis Abstract Pericarditis in patients with renal failure remains a serious problem, with mortality as high as 20%.1 The etiology is unknown and may be multifactorial. The conventional approach to treatment has been intensive (daily) dialysis, using minimal or regional heparinization for 10 to 14 days.2,3 Steroids given for systemic effect and nonsteroidal anti-inflammatory agents have also been used, but controlled studies attesting to their benefit are lacking. With the advent of maintenance dialysis, two distinct forms of this disease have emerged. In patients with pericarditis who never received dialysis (uremic pericarditis), the response rate to intensive hemodialysis is almost 90%,2 suggesting that uremia is a major causative factor. However, patients receiving maintenance hemodialysis who have pericarditis (dialysis pericarditis) have only a 10% to 40% response rate to intensified hemodialysis,1,2,4 suggesting that accumulation of dialyzable uremic toxins may not be the sole cause of the pericarditis. In fact, References 1. Ribot S, Frankel HJ, Gielchinsky I, et al: Treatment of uremic pericarditis. Clin Nephrol 1974;2:127-130. 2. Renfrew R, Buselmeier TJ, Kjellstrand CM: Pericarditis and renal failure. Ann Rev Med 1980;31:345-360.Crossref 3. Falk RJ: Pericarditis in renal failure. Kidney 1981;14:35-40. 4. Kramer P, Wigger W, Scheler F: Management of uremic pericarditis. Br Med J 1975;4:564-566.Crossref 5. Comty CM, Cohen SL, Shapiro FL: Pericarditis in chronic uremia and its sequels. Ann Intern Med 1971;75:173-183.Crossref 6. Marini PV, Hull AR: Uremic pericarditis: A review of incidence and management. Kidney Int Suppl 1975;2:163-166. 7. Silverberg S, Oreopoulus DG, Wise DJ, et al: Pericarditis in patients undergoing long-term hemodialysis and peritoneal dialysis: Incidence, complications and management. Am J Med 1977;63:874-880.Crossref 8. Fuller TJ, Knochel JP, Brennan JP, et al: Reversal of intractable uremic pericarditis by triamcinolone hexacetonide. Arch Intern Med 1976;136:979-982.Crossref 9. Osanloo E, Shalhoub RJ, Cioffi RF, et al: Viral pericarditis in patients receiving hemodialysis. Arch Intern Med 1979;139:301-303.Crossref 10. Clarkson BA: Uric acid related to uremic symptoms. Proc Eur Dial Transplant Assoc 1966;3:3-8. 11. Bailey GL, Hampers CL, Hager EB, et al: Uremic pericarditis: Clinical features and management. Circulation 1968;38:582-591.Crossref 12. Cohen GF, Burgess JH, Kaye M: Peritoneal dialysis for the treatment of pericarditis in patients on chronic hemodialysis. Can Med Assoc J 1970;102:1365-1368. 13. Ogburn HM, Ayus JC, Eknoyan G: Pericarditis in renal failure: Therapeutic considerations. Dial Transplant 1978;7:1133-1138. 14. Reddy PS, Curtiss EI, O'Toole JE, et al: Cardiac tamponade: Hemodynamic observations in man. Circulation 1978;58:265-272.Crossref 15. Kottler MN, Parry WR: Pericardial disease in chronic renal failure , in Lowenthal DT, Pennock RS, Likoff W, et al (eds): Management of the Cardiac Patient With Renal Failure . Philadelphia, FA Davis Co, 1981, p 95. 16. Wray TM, Humphreys J, Perry JM, et al: Pericardiectomy for treatment of uremic pericarditis. Circulation 1974;49-50( (suppl 2) ):II-268-271. 17. Kwasnik EM, Koster JK, Lazarus JM, et al: Conservative management of uremic pericardial effusions. J Thorac Cardiovasc Surg 1978;76:629-632. 18. Spodick DH: The management of uremic pericardial effusion. Surgery 1978;83:609. 19. Santos GH, Frater RWM: The subxiphoid approach in the treatment of pericardial effusion. Ann Thorac Surg 1977;23:468-470.Crossref 20. Fontenelle LJ, Cuello L, Dooley BN: Subxiphoid pericardial window. J Thorac Cardiovasc Surg 1971;62:95-97. 21. Luft FC, Kleit SA, Smith RN, et al: Management of uremic pericarditis with tamponade. Arch Intern Med 1974;134:488-490.Crossref 22. Popli S, Ing TS, Daugirdas JT, et al: Treatment of uremic pericardial effusion by local steroid instillation via subxiphoid pericardiotomy. J Dial 1980;4:83-89. 23. Alcan KE, Zabetakis PM, Marino ND, et al: Management of acute cardiac tamponade by subxiphoid pericardiotomy. JAMA 1982;247:1143-1148.Crossref 24. Connors JP, Kleiger RE, Shaw RC, et al: The indications for pericardiectomy in the uremic pericardial effusion. Surgery 1976; 80:689-694. 25. Ali-Regiaba S, Gay WA, Sullivan JF, et al: Treatment of uraemic pericarditis by anterior pericardiectomy. Lancet 1974;2: 12-14.Crossref 26. Engelman RM, Levitsky S, Konchigeri HN, et al: Total pericardiectomy for uremic pericarditis. World J Surg 1977;1:769-776.Crossref 27. Buselmeier TJ, Davin TD, Simmons RL, et al: Treatment of intractable uremic pericardial effusion: Avoidance of pericardiectomy with local steroid instillation. JAMA 1978;240:1358-1359.Crossref 28. Krumlovsky FA: Uremic pericarditis. Int J Artif Organs 1981;4:1-4. 29. Lornoy W, De Broe M, Hilderson J, et al: Uremic pericarditis in chronic hemodialysis patients: Treatment by surgical pericardiostomy. Acta Clin Belg 1977;32:230-234. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Early Drainage of Pericardial Effusion in Patients With Dialysis Pericarditis

Loading next page...
 
/lp/american-medical-association/early-drainage-of-pericardial-effusion-in-patients-with-dialysis-1vlzIZpoZD
Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350090039004
Publisher site
See Article on Publisher Site

Abstract

Abstract Pericarditis in patients with renal failure remains a serious problem, with mortality as high as 20%.1 The etiology is unknown and may be multifactorial. The conventional approach to treatment has been intensive (daily) dialysis, using minimal or regional heparinization for 10 to 14 days.2,3 Steroids given for systemic effect and nonsteroidal anti-inflammatory agents have also been used, but controlled studies attesting to their benefit are lacking. With the advent of maintenance dialysis, two distinct forms of this disease have emerged. In patients with pericarditis who never received dialysis (uremic pericarditis), the response rate to intensive hemodialysis is almost 90%,2 suggesting that uremia is a major causative factor. However, patients receiving maintenance hemodialysis who have pericarditis (dialysis pericarditis) have only a 10% to 40% response rate to intensified hemodialysis,1,2,4 suggesting that accumulation of dialyzable uremic toxins may not be the sole cause of the pericarditis. In fact, References 1. Ribot S, Frankel HJ, Gielchinsky I, et al: Treatment of uremic pericarditis. Clin Nephrol 1974;2:127-130. 2. Renfrew R, Buselmeier TJ, Kjellstrand CM: Pericarditis and renal failure. Ann Rev Med 1980;31:345-360.Crossref 3. Falk RJ: Pericarditis in renal failure. Kidney 1981;14:35-40. 4. Kramer P, Wigger W, Scheler F: Management of uremic pericarditis. Br Med J 1975;4:564-566.Crossref 5. Comty CM, Cohen SL, Shapiro FL: Pericarditis in chronic uremia and its sequels. Ann Intern Med 1971;75:173-183.Crossref 6. Marini PV, Hull AR: Uremic pericarditis: A review of incidence and management. Kidney Int Suppl 1975;2:163-166. 7. Silverberg S, Oreopoulus DG, Wise DJ, et al: Pericarditis in patients undergoing long-term hemodialysis and peritoneal dialysis: Incidence, complications and management. Am J Med 1977;63:874-880.Crossref 8. Fuller TJ, Knochel JP, Brennan JP, et al: Reversal of intractable uremic pericarditis by triamcinolone hexacetonide. Arch Intern Med 1976;136:979-982.Crossref 9. Osanloo E, Shalhoub RJ, Cioffi RF, et al: Viral pericarditis in patients receiving hemodialysis. Arch Intern Med 1979;139:301-303.Crossref 10. Clarkson BA: Uric acid related to uremic symptoms. Proc Eur Dial Transplant Assoc 1966;3:3-8. 11. Bailey GL, Hampers CL, Hager EB, et al: Uremic pericarditis: Clinical features and management. Circulation 1968;38:582-591.Crossref 12. Cohen GF, Burgess JH, Kaye M: Peritoneal dialysis for the treatment of pericarditis in patients on chronic hemodialysis. Can Med Assoc J 1970;102:1365-1368. 13. Ogburn HM, Ayus JC, Eknoyan G: Pericarditis in renal failure: Therapeutic considerations. Dial Transplant 1978;7:1133-1138. 14. Reddy PS, Curtiss EI, O'Toole JE, et al: Cardiac tamponade: Hemodynamic observations in man. Circulation 1978;58:265-272.Crossref 15. Kottler MN, Parry WR: Pericardial disease in chronic renal failure , in Lowenthal DT, Pennock RS, Likoff W, et al (eds): Management of the Cardiac Patient With Renal Failure . Philadelphia, FA Davis Co, 1981, p 95. 16. Wray TM, Humphreys J, Perry JM, et al: Pericardiectomy for treatment of uremic pericarditis. Circulation 1974;49-50( (suppl 2) ):II-268-271. 17. Kwasnik EM, Koster JK, Lazarus JM, et al: Conservative management of uremic pericardial effusions. J Thorac Cardiovasc Surg 1978;76:629-632. 18. Spodick DH: The management of uremic pericardial effusion. Surgery 1978;83:609. 19. Santos GH, Frater RWM: The subxiphoid approach in the treatment of pericardial effusion. Ann Thorac Surg 1977;23:468-470.Crossref 20. Fontenelle LJ, Cuello L, Dooley BN: Subxiphoid pericardial window. J Thorac Cardiovasc Surg 1971;62:95-97. 21. Luft FC, Kleit SA, Smith RN, et al: Management of uremic pericarditis with tamponade. Arch Intern Med 1974;134:488-490.Crossref 22. Popli S, Ing TS, Daugirdas JT, et al: Treatment of uremic pericardial effusion by local steroid instillation via subxiphoid pericardiotomy. J Dial 1980;4:83-89. 23. Alcan KE, Zabetakis PM, Marino ND, et al: Management of acute cardiac tamponade by subxiphoid pericardiotomy. JAMA 1982;247:1143-1148.Crossref 24. Connors JP, Kleiger RE, Shaw RC, et al: The indications for pericardiectomy in the uremic pericardial effusion. Surgery 1976; 80:689-694. 25. Ali-Regiaba S, Gay WA, Sullivan JF, et al: Treatment of uraemic pericarditis by anterior pericardiectomy. Lancet 1974;2: 12-14.Crossref 26. Engelman RM, Levitsky S, Konchigeri HN, et al: Total pericardiectomy for uremic pericarditis. World J Surg 1977;1:769-776.Crossref 27. Buselmeier TJ, Davin TD, Simmons RL, et al: Treatment of intractable uremic pericardial effusion: Avoidance of pericardiectomy with local steroid instillation. JAMA 1978;240:1358-1359.Crossref 28. Krumlovsky FA: Uremic pericarditis. Int J Artif Organs 1981;4:1-4. 29. Lornoy W, De Broe M, Hilderson J, et al: Uremic pericarditis in chronic hemodialysis patients: Treatment by surgical pericardiostomy. Acta Clin Belg 1977;32:230-234.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1983

References