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.