Early Drainage of Pericardial Effusion in Patients With Dialysis Pericarditis

Pericarditis in patients with renal failure remains a serious problem, with mortality as high as 20%.¹ The etiology is unknown and may be multifactorial. The conventional approach to treatment has been intensive (daily) dialysis, using minimal or regional heparinization for 10 to 14 days.^2,3 Steroids given for systemic effect and nonsteroidal anti-inflammatory agents have also been used, but controlled studies attesting to their benefit are lacking. With the advent of maintenance dialysis, two distinct forms of this disease have emerged. In patients with pericarditis who never received dialysis (uremic pericarditis), the response rate to intensive hemodialysis is almost 90%,² suggesting that uremia is a major causative factor. However, patients receiving maintenance hemodialysis who have pericarditis (dialysis pericarditis) have only a 10% to 40% response rate to intensified hemodialysis,^1,2,4 suggesting that accumulation of dialyzable uremic toxins may not be the sole cause of the pericarditis. In fact,