Management of Hydrothorax in Peritoneal Dialysis Systems
Summary
Hydrothorax arising in the context of peritoneal dialysis represents the translocation of dialysate from the abdominal cavity into the pleural space, most commonly through congenital or acquired defects in the diaphragm. Although relatively uncommon, this complication poses significant risks to respiratory function and ongoing dialysis efficacy. Clinicians must integrate prompt imaging‐based diagnosis, including chest radiography, computed tomography and specialised contrast studies, with careful assessment of dialysate biochemistry to confirm pleural fluid origin. Management strategies range from temporary cessation or reduction of peritoneal dialysis exchanges to targeted surgical repair of diaphragmatic defects. Non-surgical measures, such as chemical pleurodesis, may be effective in selected patients who are unfit for surgery or whose defects are not amenable to direct closure. Recent innovations have focused on minimally invasive techniques that both localise and seal the communication while preserving peritoneal dialysis as a long-term modality. Multidisciplinary coordination among nephrologists, radiologists and thoracic surgeons is essential to tailor interventions to individual anatomy, defect size and patient comorbidities, thereby optimising outcomes and maintaining quality of life.
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Management of Hydrothorax in Peritoneal Dialysis Systems publication trend
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Technical terms
Hydrothorax: accumulation of peritoneal dialysate within the pleural cavity due to diaphragmatic breach.
Pleuroperitoneal communication: abnormal channel linking the peritoneal space and pleural compartment, permitting fluid transfer.
Video-assisted thoracic surgery (VATS): endoscopic approach enabling visualisation and repair of thoracic structures through small chest incisions.
Chemical pleurodesis: instillation of a sclerosing agent into the pleural space to provoke adhesion formation and seal leaks.
References
- A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula. Surgical Case Reports (2021).
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