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Nephrol Dial Transplant (2003) 18: 2451-2452
© 2003 European Renal Association-European Dialysis and Transplant Association

Letter and Reply

Reply

Sydney Tang and Kar Neng Lai

Department of Medicine University of Hong Kong Queen Mary Hospital Hong Kong People’s Republic of China Email: scwtang{at}hkucc.hku.hk

Sir,

The objective of our study [1] was to examine the efficacy and tolerability of video-assisted thoracoscopic talc pleurodesis in the treatment of pleuroperitoneal communication in CAPD. Although spontaneous remissions have been reported in up to 38% of patients after ’resting‘ the peritoneal cavity with temporary haemodialysis [2], our unpublished experience shows that the result of such a conservative measure is often much more disappointing, at least among Chinese subjects. The socioeconomic and psychologic impact of a protracted course of temporary haemodialysis using a temporary vascular access can be substantial, particularly in places where access to haemodialysis facilities is scarce such as Hong Kong [3].

We are sceptical about the notion that 'any degree of glucose concentration in pleural fluid higher than in the blood in CAPD patients could only result from a pleuroperitoneal leak'. Existing reports in the literature in this area are scarce and mostly based on small patient numbers only. There may well be exceptions, for example, in the poorly controlled diabetic subject in whom prolonged dwelling of dialysis solution may well have allowed sufficient time for absorption of glucose by the pleural mesothelium.

Conflict of interest statement. None declared.

References

  1. Tang S, Chui WH, Tang AW et al. Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis. Nephrol Dial Transplant 2003; 18: 804–808[Abstract/Free Full Text]
  2. Nomoto Y, Suga T, Nakajima K et al. Acute hydrothorax in continuous ambulatory peritoneal dialysis—a collaborative study of 161 centers. Am J Nephrol 1989; 9: 363–367[Medline]
  3. Lai KN, Lo WK. Optimal peritoneal dialysis for patients from Hong Kong. Perit Dial Int Suppl 1999; 19: S26–S31

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This Article
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