Clinico-etiological profile of pleural effusion in chronic kidney disease

Abstract

INTRODUCTION Pleural effusion is a common complication of chronic kidney disease, arising from multiple causes. In a resource constrainted, tuberculosis endemic region like Nepal, accurate diagnosis is challenging. This study was done to assess the clinical profile and etiology of pleural effusion in CKD patients in a tertiary care center in Nepal.

METHODS This hospital based cross sectional study was conducted in the nephrology wards in Tribhuvan University Teaching Hospital over a period of 13 months. It included all patients aged ≥ 18 years with CKD stage 3 to 5D with radiologically confirmed pleural effusion who underwent diagnostic thoracentesis admitted during the study period. Pleural fluid was analyzed using Light’s criteria. Final diagnosis was recorded after comprehensive evaluation as required.

RESULTS A total of 103 patients were included in the study. The mean age was 52.69±15.15 years with slight female predominance. Most patients (56.3%) were in maintenance hemodialysis. Diabetes Mellitus was the leading cause of CKD (41.7%). Shortness of breath was the most common symptom (86.4%). 59.2% were  transudative effusion. Heart failure was the most common etiology (58.3%), followed by parapneumonic effusion (24.3%) and tubercular effusion (13.6%). Pleural fluid ADA was diagnostic in only 8 of 14 cases, remaining case required additional investigation or empirical treatment.  

CONCLUSIONS Pleural effusion in CKD has diverse causes with heart failure being the predominant cause. However, infectious etiology including tuberculosis constitute a substantial burden, necessitating a systematic evaluation especially in a TB endemic region like Nepal.