Chronic
hemodialysis (HD) patients are predisposed to several complications associated with
pleural effusion. In addition,
uremia can directly cause
pleuritis. However, there are inadequate data about pathogenesis and natural course of uremic
pleuritis. In this study, 76 chronic HD patients with
pleural effusion admitted to the Respiratory Center of Masih Daneshvari Hospital, in Tehran, Iran between June 2005 and May 2011 were evaluated to figure out the etiology of their
pleural disease. Among these patients, patients with uremic
pleuritis were identified and studied. The rate of uremic
pleuritis was 23.7%. Other frequent etiologies of
pleural effusion were parapneumonic effusion (23.7%),
cardiac failure (19.7%),
tuberculosis (6.6%), volume overload,
malignancy, and unknown. In patients with uremic
pleuritis,
dyspnea was the most common symptom, followed by
cough,
weight loss,
anorexia,
chest pain, and
fever. Compared to patients with parapneumonic effusion, patients with uremic effusion had a significantly higher rate of
dyspnea and lower rate of
cough and
fever. Pleural fluid analysis showed that these patients had a significantly lower pleural to serum lactic
dehydrogenase ratio, total pleural leukocytes, and polymorphonuclear count compared to patients with parapneumonic effusion. Improvement was achieved in 94.1% of patients with uremic
pleuritis by continuation of HD,
chest tube insertion or pleural decortication; an outcome better than the previous reports. Despite the association with an exudative effusion, inflammatory pleural reactions in patients with uremic
pleuritis may not be as severe as
infection-induced effusions. Owing to the advancement in HD technology and other interventions, outcome of uremic
pleuritis may be improved.