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Clinical |
Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, United Kingdom
Correspondence to: M.G. Coulthard, Department of Paediatric Nephrology, Royal
Victoria Infirmary, Newcastle, NE1 4LP United
Kingdom.
malcolm.coulthard{at}nuth.nhs.uk
Aim: To determine whether gradually increasing the
peritoneal dialysate fill volume from 10 to 40 mL/kg over 6 days, rather than
commencing at 40 mL/kg, prevents hydrothorax in children and reverses it if
present. Methods: A review of children peritoneally dialyzed in a
single center. Results: During the 20 years beginning June 1985, 416
children were peritoneally dialyzed, of which 327 (79%) had acute and 89 had
end-stage renal failure. Among 253 children who had gradually increasing fill
volumes, none developed acute hydrothoraces, but 13/163 (8%) who began with 40
mL/kg cycles did (p < 0.000, Fisher's exact test). These were
diagnosed after a median (range) of 48 (6-72) hours and were predominantly
right sided. Initially, we readily abandoned peritoneal dialysis; 2 were
changed to hemodialysis. Subsequently, we found that peritoneal dialysis could
be continued by using small volumes with the patients sitting up; cycle
volumes were then gradually increased again. One pre-term baby died soon after
developing an acute hydrothorax. One patient on chronic peritoneal dialysis
developed an acute hydrothorax after forceful vomiting, but recovered after
being dialyzed sitting up with low fills. Conclusion: Acute hydrothorax can be prevented and treated
using graduated cycle volumes, and is not a contraindication for peritoneal
dialysis.
KEY WORDS: KEY WORDS:; Hydrothorax; renal failure.
Received 31 May 2006; accepted 5 February 2007.
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