A Study of the Dialysis Associated Pericarditis in Patients on Undergoing Maintenance Hemodialysis

Lee, Jae Myoung; Kim, Jin Soo; Kim, Jung Kwon; Yang, Jae Won; Kim, Min Soo; Han, Byoung Geun; Choi, Seung Ok

Abstract

BACKGROUND: The accurate pathogenetic mechanism of dialysis associated pericarditis remain uncertain, but its clinical significance is very important from a therapeutic and prognostic point of view. Clinical features of the disease weren't reported well in Korea. So, we analyzed the clinical characteristics of the dialysis associated pericarditis.
METHODS
Thirty-five patients were included in this study. The study group was divided into two groups (a minimal group and moderate to large group) according to the amount of the pericardial effusion on echocardiogram. We reviewed and compared the clinical appearance, laboratory data and echocardiogram findings.
RESULTS
There were 18 cases (51.4%) of minimal amount pericardial effusion and 17 cases (48.5%) of moderate to large amount. Cardiac tamponade developed in 2 patients. There was a significant difference in urea reduction rate between minimal group (42+/-20.%) and moderate to large group (24.3+/-21.2%) (p<0.05). A time to pericardial effusion development from dialysis initiation was 3.6+/-8.3 months, 17.6+/-21.0 months, respectively and the difference showed statistical significance (p<0.05). The Left ventricular dimension at systole was 4.8+/-0.7 cm, 3.8+/-1.1 cm, respectively. This difference is statistically significant (p<0.05). In the minimal amount group, 16 (89.9%) cases were treated conservatively and 2 cases (10.1%) were treated surgically. In the moderate to large amount group, 10 cases (58.8%) were treated surgically.
CONCLUSION
These results show that the dialysis associated pericarditis with moderate to large amount of pericardial effusion have lesser urea reduction rate, longer dialysis treatment period and require further surgical approach than minimal amount group. We suggest that the sufficient and adequate dialysis and the regular echocardiography are needed. This need is more eminent as the duration of dialysis become longer. It is possible to prevent the development of pericarditis and its complication.