Management of peritoneal dialysis-induced hydrothorax in children

Continuous ambulatory peritoneal dialysis (CAPD) is a safe and effective treatment for children with end-stage renal failure. Approximately three per cent of patients develop a large hydrothorax as a result of a dialysate leak from the peritoneal cavity through an occult diaphragmatic eventration or attenuation of the pleuroperitoneal membrane. Previously, such patients often discontinued CAPD and were placed on hemodialysis even though the complications, expense, and limitation of activity with hemodialysis are undesirable in children. During the past 15 years, 6 of the 193 children (3%) undergoing CAPD at UCLA Medical Center developed a hydrothorax. Three patients were male and three were female. Four patients were treated surgically with diaphragmatic plication, one was treated by reducing the dialysate volume, and one was switched to hemodialysis in preparation for a renal transplant. Each of the four surgically-treated children was able to return to full-volume peritoneal dialysis and has not experienced recurrence of the hydrothorax. Therefore, diaphragmatic plication permits children to quickly resume full-volume CAPD and avoid hemodialysis.