Asymptomatic pericardial effusion in hemodialysis patients

Background: Pericardial effusion is seen frequently as a random finding in patients undergoing maintenance hemodialysis. The successful treatment and the uniform agreement about etiology of pericardial effusion in hemodialysis patients do not exist in spite of a lot of performed studies. Aim: The aim of this study is determination of the frequency of pericardial effusion in patients undergoing maintenance hemodialysis without typical symptoms and signs of pericarditis, and correlation of any of the series of analyzed laboratory features with the finding of pericardial effusion. Patients and methods: In the group of 120 patients without typical symptoms and signs of pericarditis and undergoing maintenance hemodialysis longer than 3.5 months, echocardiography and a number of laboratory parameters were determined (hematocrit, platelets, predialysis urea, creatinine, uric acid, calcium, phosphorus, alkaline phosphatase, AST, total serum proteins, albumin, i-PTH, Kt/V and B and C hepatitis markers). Results: Our 24 patients who were found to have pericardial effusion, i.e. asymptomatic dialysis associated pericarditis (DAP) (20%) underwent maintenance hemodialysis for a shorter period of time (39.87 +/- 30.50:66.10 +/- 52.49 months; t = 2.35 p < 0.05) when compared to patients without pericardial effusion, and their interdialysis weight gain was much lower (2.56 +/- 1.04:2.07 +/- 1.04 kg; t = 2.05, p < 0.05). Age, heparin dose, and any of a series of common laboratory test findings were unrelated with appearance of pericardial effusion. Conclusion: The patients undergoing maintenance hemodialysis and suffering from asymptomatic pericardial effusion did not differ from asymptomatic patients without pericardial effusion when compared according to any of common laboratory features. They were treated by maintenance hemodialysis for significantly shorter period of time and their interdialysis weight gain was much lower. It appears that asymptomatic pericardial effusion might not be causally related to end-stage renal disease or its treatment, and that attemps at understanding of the cause of the appearance of pericardial effusion should consider completely different parameters.