Profile of pleural effusion in chronic kidney disease patients undergoing hemodialysis

Background: A number of complications related to the respiratory system occur in patients with chronic kidney disease (CKD). Pleural effusion in such patients is a common diagnostic dilemma as it may arise from CKD itself or due to concomitant infections. In the present study, we retrospectively studied the occurrence, causes, clinical features and management issues of pleural effusion in patients with CKD on hemodialysis. Material and Methods: Study is conducted on 50 CKD patients on hemodialysis admitted in the various medical wards of the Mc Gann Hospital attached to the Shimoga Institute of Medical Sciences, Shimoga from January 1st 2017 to September 30th 2017. A detailed history was taken in all the patients and a through physical examination was done. Blood was collected for analysis of Hb, blood urea, serum electrolyte, serum calcium, phosphorus, serum albumin, serum cholesterol, serum creatinine, electocardiography, HIV serology, hepatitis B surface antigen (HBsAg), anti-hepatitis C antibody (Anti HCV), sputum for Ziehl-Neelsen (Z-N) stain, urine for routine and microscopic examination  recorded in the case records were studied.  Echocardiography was done. Chest radiograph (postero-anterior views) was reviewed. Pleural fluid analysis for cell type, cell count, protein, sugar, gram stain and AFB were recorded. Results: There were 35 males and 15 females. Average age is 46±11.6 years. The majority of these patients belong to the age group of 41-50 years (38%). Anemia (90%) and hypertension (88%) were commonest associations. IHD was seen in 42%. Commonest symptom was fatigue (90%) followed by dyspnea (84%) followed by cough (80%) and pedal edema (72%). Moderate pleural effusion (70%) was seen in majority of cases. Right sided (60%) unilateral (70%) effusion was common. Transudative effusion was common (64%). Out of 18 exudative pleural effusions 12 were para-pneumonic effusions. Out of 32 transudative pleural effusions 4 were due to volume overload. The Mean±SD of total leucocyte count of exudative pleural effusion was (335±145), tubercular pleural was 75±25 and cardiac failure pleural effusion was 15±9. Lymphocytes were predominant in tubercular pleural effusion (76±22) followed by uremia (75±19).  Neutrophils were predominant in para-pneumonic effusions (66±23). Conclusions: This study concludes that substantial number of patients with CKD suffers from respiratory diseases, most common of which is pleural effusion. Etiologies of these are multifactorial. Early thoracentesis should be done as management in such cases. Keywords: CCF; CKD; Hemodialysis; Pleural effusion; Thoracocentesis