Recent studies show the incidence of renal failure as a common cause of pericardial disease, including pericardial effusions in men around 50 + years old who have been diagnosed with a large pericardial effusion. Advances in treatments for patients and the increase in research related to this disease, have decreased the incidence of patients with Pericarditis and renal failure, but this problem is still relatively frequent and causes occasional mortality in some of its patients.
Uremic pericarditis has long been considered as a sign of impending death. The introduction of intermittent dialysis and renal transplantation in addition to a new diagnostic test has improved the outlook for uremic patients. Many patients with chronic renal failure can be rehabilitated and their pericarditis frequently disappears. However, cardiac tamponade is more commonly recognized and is more synonymous with prolonged survival if adequately treated.
2 Forms Of Pericarditis and Renal Failure
1) Uremic pericarditis: Uremic pericarditis has been diagnosed in 6 to 10 percent of patients with advanced renal failure (acute or chronic). It results from inflammation of the visceral and parietal membranes of the pericardial sac.
There is a rough correlation with the degree of uremia (a form of blood poisoning caused by the accumulation in the blood of products that are normally eliminated in the urine) although the cause, development, and effects of the disease is poorly understood.
2) Dialysis-associated pericarditis and renal failure: 13 percent of patients who had been on maintenance hemodialysis are diagnosed with pericarditis and may occasionally be seen with chronic peritoneal dialysis (CAPD).
Either could be due to an inadequate dialysis or the presence of fluid overload. Precise diagnosis and examination of the pericardium typically shows adhesions between the pericardial membranes – which are thicker than normal.
Bloody fluid is present, perhaps due in part to the frequent destruction in the platelet (tiny colorless disk-shaped particle found in large quantities in the blood which plays an important part in the clotting process during renal failure).
Symptoms of Patients With Pericarditis And Renal Failure
The clinical features of pericarditis and renal failure are similar to those observed with pericarditis due to other causes. Most patients complain of fever and pleuritic chest pain, the intensity of which can be variable.
The pain is characteristically worse when the patient is lying down or resting on their back. A pericardial rub is generally audible, but is usually temporary.
Signs of cardiac tamponade may be seen, particularly in patients with rapid pericardial fluid accumulation. Cardiac ultrasonography reveals a pericardial effusion in at least 50 percent of cases.
Dialysis of Patients With Pericarditis And Renal Failure
When a patient with an unexplained case of pericarditis shows symptoms of advanced renal failure, dialysis may be undertaken; this may only happen after the patient has been tested to ensure that there is no circulatory compromise or evidence of impending tamponade.
Most patients with uremic pericarditis respond rapidly to dialysis with a decrease in the amount of chest pain as well as a decrease in the size of the pericardial effusion. Either heparin-free hemodialysis or peritoneal dialysis may be used.
“It is very important to verify the patient’s test results before treatment begins; in patients with a tamponade or pre-tamponade, an acute fluid removal with hemodialysis can lead to cardiovascular collapse. On the other hand, if the treatment of choice is peritoneal dialysis, there is a possibility of a compromise in respiratory function due to intra-peritoneal accumulation”.
The type of dialysis therapy is usually determined by availability and the long term plans for the patient with chronic end-stage renal disease. Doctors should take into consideration the age of the patient, as well as the results of tests during the treatment to verify that no complications have developed as a result of the treatment.
It’s important to note that acute cardiac tamponade with circulatory collapse should be treated with pericardiocentesis. Alternatively, plasma volume expanders (such as albumin) may effectively support the blood pressure until surgery can be performed. You can read more on Pericarditis and renal failure here