Treatment of uremic pericarditis and pericardial effusion.

Pericarditis occurred 161 times in 136 of 1,058 patients undergoing chronic dialysis during a period of 13.7 years. Cardiac tamponade occurred during 27 episodes, while pretamponade occurred in 30. Tamponade was less frequent and resolution of pericarditis without invasive intervention more frequent when pericarditis occurred within 2 weeks of initiation of chronic dialysis. Similarly, resolution with conservative therapy was more frequent with first episodes than with recurrences, and when pericarditis occurred within 3 months of initiation of chronic dialysis. The overall survival was 89.7% and was the same irrespective of the duration of dialysis or whether the pericarditis was a first episode or a recurrence. We recommend that patients with pericarditis and no hemodynamic alterations receive intensive hemodialysis, with careful hemodynamic and echocardiographic monitoring, as primary treatment. Invasive intervention is indicated if cardiac tamponade or pretamponade develops, if a pericardial effusion increases progressively in size, or if a large effusion persists after ten to 14 days of intensive dialysis. In our experience, the invasive intervention of choice is either formal pericardiectomy or subxiphoid pericardiotomy with intrapericardial steroid instillation. In our experience, pericardiocentesis has proven to be a high-risk procedure. It is reserved for emergency circumstances, and then is preferably performed in the operating room just prior to induction of anesthesia for definitive surgical drainage.