A case of cardiac tamponade due to uremic pericarditis caused by dialysis withdrawal

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  • 透析自己中断により尿毒症性心外膜炎による心タンポナーデをきたした1例
  • トウセキ ジコ チュウダン ニ ヨリ ニョウドクショウセイシン ガイマクエン ニ ヨル シン タンポナーデ オ キタシタ 1レイ

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<p>A 49-year-old man undergoing maintenance hemodialysis due to diabetic nephropathy was admitted to our hospital because of dyspnea after self-interruption of dialysis for two weeks. We initiated urgent hemodialysis because of uremia. After several sessions of hemodialysis, he recovered from hyperkalemia, hypernitrogenemia, and dyspnea. However, there was only a mild improvement of cardiomegaly on chest X-ray, although we performed hemodialysis with ultrafiltration for fluid removal. His blood pressure had reduced after hemodialysis on day 7 of admission, and then his blood pressure dropped to 60 mmHg on day 9 of admission. Echocardiography demonstrated the cardiac tamponade with massive pericardial effusion. We performed pericardiocentesis and drained the bloody pericardial fluid, and we changed the anticoagulant during dialysis from heparin to nafamostat. His blood pressure was improved after pericardial drainage for two days. We diagnosed the patient with uremic pericarditis after ruling out infectious diseases and malignancy. With the progress of hemodialysis treatment, uremic pericarditis has become rare, and to our best knowledge, this is the first case report of a maintenance dialysis patient who developed uremic pericarditis on withdrawing from dialysis. This case suggests that to prevent cardiac tamponade, we should take care regarding the choice of anticoagulant and volume of fluid removal in addition to intensified dialysis, which is known as primary therapy.</p>

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