UREMIC PERICARDITIS - PREVENTION OF COMPLICATIONS

Fifty-three consecutive patients with uremic pericarditis seen from Oc tober '91 to May '94 were analyzed. They were classified in three cate gories according to the amount of pericardial effusion on echocardiogr aphy. Group I (n = 18) mild effusion, Group II (n = 16) moderate effus ion and Group III (n = 19) extensive effusion. Intensive hemodialysis (HD) was done in 51, repeated pericardiocentesis or continuous drainag e in 14 and pericardial window in 20 patients. Fifteen patients in gro up I improved with HD as compared to 4 in group II and none in group I II (p < 0.001). Of 14 patients who underwent repeated aspiration or co ntinuous drainage, three improved and 11 died, because of persistent t amponade (2), ventricular arrhythmias (3), and recurrence of tamponade (6). Pericarditis resolved in 19 of the patients who underwent perica rdial window; one patient died. The data suggests that (a) cardiac tam ponade is an important cause of preventable death (23%) in patients wi th uremic pericarditis, (b) intensive dialysis is effective in mild bu t not in moderate to extensive pericardial effusion and (C) pericardio centesis and continuous drainage are ineffective in preventing develop ment of cardiac tamponade or death in the latter group. We recommend t hat patients with moderate to extensive and progressive pericardial ef fusion be considered for pericardial window on an elective basis befor e the onset of cardiovascular compromise.