Continuous ambulatory peritoneal dialysis (
CAPD) is a safe and effective treatment for children with
end-stage renal failure. Approximately three per cent of patients develop a large
hydrothorax as a result of a
dialysate leak from the peritoneal cavity through an occult
diaphragmatic eventration or attenuation of the pleuroperitoneal membrane. Previously, such patients often discontinued
CAPD and were placed on
hemodialysis even though the complications, expense, and limitation of activity with
hemodialysis are undesirable in children. During the past 15 years, 6 of the 193 children (3%) undergoing
CAPD at UCLA Medical Center developed a
hydrothorax. Three patients were male and three were female. Four patients were treated surgically with diaphragmatic plication, one was treated by reducing the
dialysate volume, and one was switched to
hemodialysis in preparation for a renal transplant. Each of the four surgically-treated children was able to return to full-volume
peritoneal dialysis and has not experienced recurrence of the
hydrothorax. Therefore, diaphragmatic plication permits children to quickly resume full-volume
CAPD and avoid
hemodialysis.