Abstract
Editor:
Acute pericarditis remains a relatively common complication in dialysis patients. Although treatment of pericarditis in hemodialysis patients is well established (1), data concerning prevalence and treatment of this condition in continuous ambulatory peritoneal dialysis (CAPD) patients are scarce and, frequently, those patients are treated with hemodialysis.
We report our experience with 3 CAPD patients who suffered three episodes of acute pericarditis and were successfully treated with intensification of their CAPD treatment.
Among 61 patients on CAPD, 3 presented with acute pericarditis from January 1995 to October 1999, which amounts to 0.03 episodes/patient/year. There were 2 females and 1 male. The patients’ ages were 62, 56, and 38 years, respectively, and the mean time on CAPD was 9 months (range 3 – 17 months). Dialysis efficiency parameters were as follows: Kt/V 1.9, 2.1, and 2.1; creatinine clearance 60, 58, and 74 L/ week/1.73 m2; and urea clearance 66, 57, and 60 L/ week.
The presenting symptoms were fever in 2 patients, chest pain in 1, and asthenia in 1. A pericardial friction rub was heard in all 3 patients. Blood pressure was normal and echocardiography showed pericardial effusion in all patients.
In our dialysis unit, the standard treatment of acute pericarditis is daily hemodialysis without heparin. However, we proposed to these stable patients an intensive peritoneal dialysis schedule as treatment of pericardial effusion. The treatment consisted of 2-L peritoneal exchanges every 2 hours for 12 – 15 hours per day (exchanges were not performed during sleeping time) and indomethacin 50 mg twice per day.
With this treatment, chest pain disappeared in a mean of 3 days, rub in 6 days, fever in 1 day, and pericardial effusion in 8 days. One episode was complicated with auricular fibrillation, which was treated with oral amiodarone. Pericarditis totally resolved (absence of pericardial effusion on echocardiography) in 4, 10, and 11 days, respectively.
In conclusion, CAPD patients with acute pericarditis (mainly uncomplicated pericarditis) can be safely and efficiently treated with intensification of their peritoneal dialysis schedule. The duration of treatment can be compared favorably with pericarditis in hemodialysis patients.