Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis

Nephrol Dial Transplant. 2003 Apr;18(4):804-8. doi: 10.1093/ndt/gfg042.


Background: Acute, massive, unilateral hydrothorax is an uncommon but well-recognized complication of peritoneal dialysis. Its clinical course and treatment outcome after a recently advocated technique of video-assisted thoracoscopic (VATS) talc pleurodesis remains unclear.

Methods and results: Between July 1998 and March 2002, among 475 CAPD patients in two regional hospitals in Hong Kong, nine patients (three men, six women, mean age 53+/-12 years) developed acute hydrothorax due to pleuroperitoneal communication (R=8, L=1) within 5.8+/-4.2 months (median, 5.2 m; range, 2 days to 11.6 months) of commencing peritoneal dialysis. Analysis of simultaneously obtained peritoneal and pleural fluid in all subjects only showed concordance in protein content (consistently<4 g/l), while fluid glucose and lactate dehydrogenase levels were not comparable. The methylene blue test was negative (n=4). Radionuclide scan (n=6) and contrast CT peritoneography (CTP, n=3) detected pleuroperitoneal communication in half and one-third of the patients, respectively. All patients underwent pleurodesis achieved by talc insufflation into the pleural cavity under VATS guidance. All patients were successfully returned to peritoneal dialysis. After a mean follow-up of 18.8+/-12.5 months, hydrothorax recurred in one patient (at 7 months after pleurodesis), who was successfully treated by repeating the procedure.

Conclusions: Hydrothorax complicating CAPD is more commonly right-sided, and tends to occur within the first year of starting peritoneal dialysis. Isotope scan and CTP are insensitive in diagnosing pleuroperitoneal communication. A low pleural fluid protein content is the most consistent biochemical finding. VATS talc pleurodesis is a safe and reliable treatment of choice that allows sustained continuation of CAPD with low recurrence rate.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Analysis of Variance
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrothorax / etiology*
  • Hydrothorax / therapy*
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Peritoneal Dialysis, Continuous Ambulatory / adverse effects*
  • Peritoneal Dialysis, Continuous Ambulatory / methods
  • Pleurodesis / methods*
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Sampling Studies
  • Severity of Illness Index
  • Talc
  • Thoracoscopy / methods*
  • Treatment Outcome
  • Video Recording


  • Talc