Abstract: FR-PO569
Pleuroperitoneal Leak in Peritoneal Dialysis Patients: Experience of a Single Center
Session Information
- Dialysis and Vascular Trainee Case Reports
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 703 Dialysis: Peritoneal Dialysis
Authors
- Nava, Marcos Garcia, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de Mexico, Mexico
- Leal, Gabriela, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de Mexico, Mexico
- Cano Escobar, Karla Bernice, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de Mexico, Mexico
Introduction
Pleuroperitoneal leak (PPL) is a rare complication, incidence reported between 1.6-10%.Etiology include congenital and acquired defects in the diaphragmatic muscle fibres, favored by increase intraabdominal pressure due to peritoneal dialysis solutions. The objective is to report the incidence,diagnosis,treatment and evolution of PPL.
Case Description
Descriptive,retrospective study. We analyzed all cases of PPL in the last 3 years.
Discussion
We found 5 patients with the diagnostic of PPL (Table 1). The male gender predominated, vintage of peritoneal dialysis (5-22 months) Diagnosis was suspected with clinical presentation, chest x –ray, difference between plasmatic and pleural effusion glucose (the pleural higher than plasmatic), and confirmed with scintigraphy. All patients required endopleural tube and peritoneal cavity rest with change of modality to hemodialysis. In 4 of the 5 patients an attempt was made to return to peritoneal dialysis (PD), but PPL recurred in all.The prognosis is discouraging due to the high recurrence rate.We included biompedance data, none of the patients had sarcopenia, ruling out this condition as a risk factor to develop diafragmatic defect, the only biochemical association was with hypoalbuminemia.
Characteristics of all patients
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | |
| Modality | CAPD | APD | CAPD | CAPD | APD |
| Time in peritoneal dialysis until diagnosis (months) | 5 | 22 | 10 | 5 | 5 |
| Albumin (g/dL) | 2.74 | 3.28 | 3.03 | 2.35 | 3.32 |
| Appendicular lean body mass index (kg/m2) | 8.82 | 6.7 | 7.2 | 7.5 | 8.4 |
| Sarcopenia (Reference Values Healthy Mexican Population) | No | No | No | No | No |
| Location | Bilateral | Right | Bilateral | Right | Right |
| Peritoneal Scintigraphy Report | Positive | Negative | Positive | Positive | Positive |
| Initial Treatment | Endopleural Tube | Endopleural Tube | Endopleural Tube | Endopleural tube + Pleurodesis | Endopleural Tube |
| Cavity Rest (weeks) | 6 | 4 | 8 | 7 | 32 |
| Final Renal Replacement Therapy | HD | HD | HD | HD | HD + Kidney Transplant |