Recurrent pleural effusion secondary to peritoneal dialysis (PD hydrothorax) occurs in about 2% of patients on continuous ambulatory peritoneal dialysis (CAPD). It can potentially be a serious problem, resulting in permanent cessation of CAPD and transition to hemodialysis. This can have many adverse consequences for some patients. Thoracic surgeons are often called upon by nephrologists for a solution to this problem.

It is thought to occur as a result of movement of peritoneal dialysate through fenestrations in the diaphragm or pleuroperitoneal communications, facilitated by the negative intrathoracic pressure. Pleural fluid analysis typically detects a higher glucose concentration than serum.

Conservative management with temporary interruption of PD has a poor success rate, whereas the efficacy of thoracoscopic intervention has been associated with success rates exceeding 90%. In this video, the authors demonstrate and discuss their approach for the thoracoscopic management of PD hydrothorax.

References

1. Chow KM, Szeto CC, Li PK. Management options for hydrothorax complicating peritoneal dialysis. Semin Dial. Sep-Oct 2003;16(5):389-94. [3]
2. Yaxley J, Twomey K. Peritoneal dialysis complicated by pleuroperitoneal communication and hydrothorax. Ochsner J. 2017 Spring;17(1):124–127. [4]
3. Yen H-T, Lu H-Y, Liu HP, Hsieh M-J. Video-assisted thoracoscopic surgery for hydrothorax in peritoneal dialysis patients – check-air-leakage method. Eur J Cardiothorac Surg. 2005 Oct;28(4):648-649. [5]

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