PLEURAL EFFUSIONS IN HOSPITALIZED-PATIENTS RECEIVING LONG-TERM HEMODIALYSIS

Objective: To determine the incidence, causes, and clinical features o f pleural effusions in hospitalized patients receiving long-term hemod ialysis. Design: Retrospective. Participants: One hundred patients rec eiving hemodialysis for at least 3 months with pleural effusion hospit alized at the Medical University of South Carolina hospitals. Results: The incidence of pleural effusions in hospitalized patients receiving long-term hemodialysis was 21%. The mean (+/-SEM) age was 55+/-1.4 ye ars and the male to female and black to white ratios were 3:2, Pleural effusions resulted from heart failure in 46% and nonheart failure cau ses in 54%, Uremic pleurisy (n=16), parapneumonic effusion (n=15), and atelectasis (n=11) accounted for most of the nonheart failure causes of pleural effusions. Three of 15 (20%) parapneumonic effusions were e mpyemas. The presence of chest pain was not different in patients with parapneumonic effusions than in other patients with nonheart failure effusion (aIIp=NS) but was more frequent compared to those with heart failure (p=0.006). Patients with parapneumonic effusions (p=0.0006) an d atelectasis (p=0,003) were more likely to have unilateral pleural ef fusions than patients with heart failure. Conclusions: Pleural effusio ns are common in hospitalized patients receiving chronic hemodialysis, Although heart failure was the most common cause, other diseases were responsible for most of the effusions, The presence of a unilateral e ffusion suggests a diagnosis other than heart failure, most commonly p arapneumonic effusion or atelectasis and deserves prompt thoracentesis as these effusions often cannot be reliably differentiated clinically . The reduced humoral and cellular immunity, in addition to delay in d iagnosis because of an attenuated clinical response, may explain the h igh rate of empyemas in this study population.