Pericarditis and Pericardial Effusions in End‐Stage Renal Disease

Abstract

Pericarditis and pericardial effusions are not uncommon in patients with end-stage renal disease (ESRD). Etiologies include those found in the general population along with two entities unique to patients with kidney disease, namely uremic and dialysis-associated pericarditis. Uremic pericarditis has been arbitrarily defined as pericarditis that develops before or within 8 weeks of initiation of dialysis, while dialysis-associated pericarditis is used to define pericarditis in patients on dialysis for more than 8 weeks. Retention of uremic toxins is likely a major contributor to uremic and dialysis-associated pericarditis although their exact cause is not known. Indeed, whether they are actually distinct entities is uncertain. Symptoms and signs of pericarditis differ in patients with ESRD compared to the non-ESRD population. Management has not been well studied and ranges from initiation and intensification of dialysis to percutaneous or open drainage for large effusions. This review covers the literature on this topic but emphasizes that most of the data are old and of relatively poor quality, and therefore additional research is needed.

Clinical predictors and outcomes of patients with pericardial effusion in chronic kidney disease

“…The prevalence of uremic pericarditis among patients on dialysis ranged from 16% to 41% . These patients benefit from initiation or intensification of dialysis . The prevalence of pericardial effusion is 13% to 38% in patients starting dialysis and 30% among those established on dialysis .…”

Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end‐stage renal disease: Insights and pathophysiology

“…Cardiac enzymes may be elevated in ESRD, which in patients with normal renal function may indicate myocardial damage. No statistical difference in blood urea nitrogen levels in patients with or without uremic or dialysis pericarditis has been found …”

“…Echocardiography (Figure ) is the diagnostic procedure of choice if acute pericarditis is suspected . It also helps assess myocarditis with alteration in ventricular function, or constriction .…”

“…Echocardiography (Figure ) is the diagnostic procedure of choice if acute pericarditis is suspected . It also helps assess myocarditis with alteration in ventricular function, or constriction . Other imaging modalities including cardiac magnetic resonance (Figure ) and computed tomography (CT) (Figure ) can be employed to diagnose complicated or questionable pericarditis .…”

“…29 It also helps assess myocarditis with alteration in ventricular function, or constriction. 29 Other imaging modalities including cardiac magnetic resonance ( Figure 2) and computed tomography (CT) (Figure 3) can be employed to diagnose complicated or questionable pericarditis. 2 31 Determining the nature of effusion through imaging will help guide diagnosis earlier, even before pericardial fluid is obtained.…”