Pericardial involvement in end stage renal disease

Our definition of pericardial involvement in end stage renal disease includes all types of pericardial disease in uremic patients, whether or not they have started any modality of dialysis. We therefore agree that the term uremic pericarditis should be reserved for pericardial involvement in advanced uremia, assuming that pericardial disease in patients on hemodialysis might have a different etiology and pathogenesis (1, 2). Uremic pericarditis is an example of the changes brought about by the advances in medicine in the incidence, clinical presentation and outcome of several diseases. The response of the pericardium to far advanced uremia, in the form of a fibrinous exudate with adhesion between the two layers and invasion and organization of the space between them has long been known as a complication that often heralds death (3–6). Its evolution to cardiac tamponade was considered to be exceptional (7), probably because the patients died without the benefit of dialysis. The introduction of dialysis has modified the history of this condition, reducing the incidence of uremic pericarditis while resulting in the more common development of tamponade. Usually, tamponade develops during the dialysis session or immediately afterwards (8–15). This condition, which is potentially lethal, has given rise to a variety of therapeutic approaches ranging from intensification of dialysis (12, 14, 16) to drainage of pericardial effusion (8, 9, 12, 14, 16–22).