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Wu J, Li X, Zhang H, Lin L, Li M, Chen G, Wang C. Development and validation of a prediction model for all-cause mortality in maintenance dialysis patients: a multicenter retrospective cohort study. Ren Fail 2024; 46:2322039. [PMID: 38415296 PMCID: PMC10903750 DOI: 10.1080/0886022x.2024.2322039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/17/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The mortality risk varies considerably among individual dialysis patients. This study aimed to develop a user-friendly predictive model for predicting all-cause mortality among dialysis patients. METHODS Retrospective data regarding dialysis patients were obtained from two hospitals. Patients in training cohort (N = 1421) were recruited from the Fifth Affiliated Hospital of Sun Yat-sen University, and patients in external validation cohort (N = 429) were recruited from the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The follow-up endpoint event was all-cause death. Variables were selected by LASSO-Cox regression, and the model was constructed by Cox regression, which was presented in the form of nomogram and web-based tool. The discrimination and accuracy of the prediction model were assessed using C-indexes and calibration curves, while the clinical value was assessed by decision curve analysis (DCA). RESULTS The best predictors of 1-, 3-, and 5-year all-cause mortality contained nine independent factors, including age, body mass index (BMI), diabetes mellitus (DM), cardiovascular disease (CVD), cancer, urine volume, hemoglobin (HGB), albumin (ALB), and pleural effusion (PE). The 1-, 3-, and 5-year C-indexes in the training set (0.840, 0.866, and 0.846, respectively) and validation set (0.746, 0.783, and 0.741, respectively) were consistent with comparable performance. According to the calibration curve, the nomogram predicted survival accurately matched the actual survival rate. The DCA showed the nomogram got more clinical net benefit in both the training and validation sets. CONCLUSIONS The effective and convenient nomogram may help clinicians quantify the risk of mortality in maintenance dialysis patients.
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Affiliation(s)
- Jingcan Wu
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xuehong Li
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hong Zhang
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Lin Lin
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Gangyi Chen
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Cheng Wang
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
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Zhang F, Xiang T, Feng X, Zhang G, Liu Y, Li L. Pleural effusion portends a poor prognosis in patients on continuous ambulatory peritoneal dialysis. PLoS One 2024; 19:e0297343. [PMID: 38241413 PMCID: PMC10798541 DOI: 10.1371/journal.pone.0297343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
AIMS Pleural effusion is not an infrequent complication in patients undergoing continuous ambulatory peritoneal dialysis. However, there is not adequate data to evaluate pleural effusion and prognosis in clinical practice. In this study, we validated this potential association by a multicenter cohort. METHODS We screened 1,162 patients who met the inclusion criteria with PD. According to the existence of pleural effusion on stable dialysis (4-8 weeks after dialysis initiation), the participants were divided into pleural effusion and non-pleural effusion groups. The hazard ratios (HRs) of all-cause and cause-specific death were estimated with adjustment for demographic characteristics and multiple potential clinical confounders. Subgroup analysis and propensity score matching (PSM) were used to further verify the robustness of the correlation between hydrothorax and prognosis. RESULTS Pleural effusion was found in 8.9% (104/1162) of PD individuals. After adjusting for the confounding factors, patients with pleural effusion had significantly increased HRs for all-cause death was 3.06 (2.36-3.96) and cardiovascular death was 3.78 (2.67-5.35) compared to those without pleural effusion. However, it was not associated with infectious and other causes of death. After PSM, the HR of all-cause mortality was 3.56 (2.28-5.56). The association trends were consistent in the subgroup sensitivity analysis. CONCLUSION Pleural effusion is not rare in PD, and is significantly associated with overall and cardiovascular mortality, which is independent of underlying diseases and clinically relevant indicators.
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Affiliation(s)
- Fengping Zhang
- Department of Nephrology, Jiujiang NO.1 People’s Hospital, Jiujiang, China
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Ting Xiang
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoran Feng
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Guilin Zhang
- Department of Nephrology, The NO.1 Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Liu
- Department of Nephrology, Pingxiang People’s Hospital, Pingxiang, China
| | - Luohua Li
- Department of Nephrology, Jiujiang NO.1 People’s Hospital, Jiujiang, China
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Jabbar A, Qureshi R, Nasir K, Dhrolia M, Ahmad A. Transudative and Exudative Pleural Effusion in Chronic Kidney Disease Patients: A Prospective Single-Center Study. Cureus 2021; 13:e18649. [PMID: 34786244 PMCID: PMC8578877 DOI: 10.7759/cureus.18649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of the study is to assess the incidence of pleural effusion and to assess its etiology in admitted chronic kidney disease patients who were admitted secondary to various causes, i.e., fluid overload, sepsis, etc. Material and methods A prospective cross-sectional observational study was conducted at the Department of Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi. A total of 789 patients were admitted between August 2020-February 2021. This study comprised 280 adult chronic kidney disease (chronic kidney disease and end-stage renal disease patients who were on dialysis) patients having pleural effusion (either unilateral or bilateral) secondary to various causes. Results Among 280 patients, the mean age was 55 years with 158 (56.4%) males and 122 (43.6%) females, diabetes (76%) was present in most of the patients along with hypertension (86.1%), and most of the patients were of stage IV and V. Transudative pleural effusion was present in 212 (75.7%) patients secondary to fluid overload and heart failure was the commonest cause while 68 (24.3%) patients had exudative pleural effusion with tuberculosis being the commonest etiology, 44 (15.7%) patients needed intervention while 236 (84.3%) were treated medically. The data was entered and analyzed on SPSS version 21 (IBM Corp, Armonk, USA). The cleaning and coding of data were done before analysis. Continuous variables were expressed in mean ± standard deviation, while the frequencies with percentages were obtained for categorical variables. The Chi-square test was applied to see the association between variables. A p-value of ≤ 0.05 was considered significant. Conclusion Clarification of the cause of pleural effusion is essential. Early diagnosis and prompt treatment like thoracocentesis or in the case of patients on hemodialysis, adequate dialysis may be necessary.
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Affiliation(s)
- Asfia Jabbar
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Ruqaya Qureshi
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Kiran Nasir
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Murtaza Dhrolia
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Aasim Ahmad
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
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Seo HM, Kim M, Kim H. Refractory exudative pleural effusion in patients with chronic kidney disease not receiving dialysis: A case report. Clin Case Rep 2019; 7:675-679. [PMID: 30997062 PMCID: PMC6452446 DOI: 10.1002/ccr3.2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/26/2019] [Accepted: 02/03/2019] [Indexed: 11/27/2022] Open
Abstract
Although exudative pleural effusion can be caused by infections, malignancies, and connective tissue diseases, we need to consider uremic pleural effusion and pleuritis in differential diagnosis of exudative lymphocyte predominant pleural effusion in patients with chronic kidney disease not receiving dialysis.
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Affiliation(s)
- Hye Mi Seo
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University HospitalJeju National UniversityJeju CityKorea
| | - Miyeon Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University HospitalJeju National UniversityJeju CityKorea
| | - Hyunwoo Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University HospitalJeju National UniversityJeju CityKorea
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Pleural Effusion in End Stage Renal Failure Patients. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:54-57. [PMID: 33536828 PMCID: PMC7847734 DOI: 10.14744/semb.2018.40327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/27/2018] [Indexed: 11/21/2022]
Abstract
Objectives: The aim of this study was to determine the causes of pleural effusion in patients who experienced end-stage renal failure and did not demonstrate any regression of effusion with dialysis treatment. Methods: Patients with pleural effusion that did not regress though they attained dry weight with dialysis and those with 2 years of follow-up were included in the study. The mean age of the patients was 48.16±14.5 years. Thirty-five patients were receiving hemodialysis treatment and 8 (18%) were continuous peritoneal dialysis patients. Ascites Ascites (n=6), pleural effusion (n=13), both ascites and pleural effusion (n=5), and pleural effusion that was bilateral (n=22, 51%), right-sided (n=13, 30%), and left-sided (n=8:18%) were detected. According to Light’s criteria, the pleural effusion was classified as exudate in 40 (93%) cases and transudate in 3 (7%). Microbiological examination did not identify any pathological agent in any case, and cytological examinations did not reveal atypical cells. The causes of pleural effusion were infection (tuberculosis: n=20, 46%), pneumonia (n=3, 7%), empyema (n=1, 2%), malignancy (lung cancer: n=3, 7%; renal carcinoma: (1, 2%), collagen diseases (n=1, 2%), hepatic abscess (n=1, 2%), pulmonary thromboembolism (n=2, 4%), and idiopathic causes (n=11, 25%). Results: The causes of pleural effusion were infection (tuberculosis: n=20, 46%), pneumonia (n=3, 7%), empyema (n=1, 2%), malignancy (lung cancer: n=3, 7%; renal carcinoma: n=1, 2%), collagen disease (n=1, 2%), hepatic abscess (n=1, 2%), pulmonary thromboembolism (n=2, 4%), and idiopathic cases (n=11, 25%). Conclusion: Tuberculosis was the most common cause of pleural effusion that did not regress with dialysis treatment.
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Hamada S, Sano T, Nagatani Y, Tsukino M. Pleural effusion negatively impacts survival of patients undergoing maintenance hemodialysis. Pulmonology 2018; 25:58-60. [PMID: 30509856 DOI: 10.1016/j.pulmoe.2018.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- S Hamada
- Department of Respiratory Medicine, Hikone Municipal Hospital, 1882, Hassakacho, Hikone 522-8539, Japan.
| | - T Sano
- Department of Urology, Hikone Municipal Hospital, 1882, Hassakacho, Hikone 522-8539, Japan
| | - Y Nagatani
- Department of Urology, Hikone Municipal Hospital, 1882, Hassakacho, Hikone 522-8539, Japan
| | - M Tsukino
- Department of Respiratory Medicine, Hikone Municipal Hospital, 1882, Hassakacho, Hikone 522-8539, Japan
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Affiliation(s)
- Apurwa Karki
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 21610, United States
| | - Leonard Riley
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 21610, United States
| | - Hiren J Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 21610, United States
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 21610, United States.
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Usefulness of Medical Thoracoscopy in the Management of Pleural Effusion Caused by Chronic Renal Failure. J Bronchology Interv Pulmonol 2017; 24:285-289. [DOI: 10.1097/lbr.0000000000000421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Walker SP, Morley AJ, Stadon L, De Fonseka D, Arnold DT, Medford ARL, Maskell NA. Nonmalignant Pleural Effusions: A Prospective Study of 356 Consecutive Unselected Patients. Chest 2017; 151:1099-1105. [PMID: 28025056 DOI: 10.1016/j.chest.2016.12.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pleural effusion secondary to a nonmalignant cause can represent significant morbidity and mortality. Nonmalignant pleural effusion (NMPE) is common, with congestive heart failure representing the leading cause. Despite this, there are limited data on mortality risk and associated prognostic factors. METHODS We recruited 782 consecutive patients presenting to a pleural service between March 2008 and March 2015 with an undiagnosed pleural effusion. Further analysis was conducted in 356 patients with NMPE. Pleural biochemical analysis, cytologic analysis, thoracic ultrasonography, and chest radiography were performed. Echocardiography, CT imaging, radiologically guided biopsy, and medical thoracoscopy were undertaken as clinically indicated. Patients were followed for a minimum duration of 12 months, with the final diagnosis decided through independent review by two respiratory consultants. RESULTS Of the 782 patients, 356 were diagnosed with NMPE (46%). These patients had a mean age of 68 years (SD, 17 years) with 69% of them being men. Patients with cardiac, renal, and hepatic failure had 1-year mortality rates of 50%, 46%, and 25%, respectively. Bilateral effusions (hazard ratio [HR], 3.55; 95% CI, 2.22-5.68) and transudative effusions (HR, 2.78; 95% CI, 1.81-4.28) were associated with a worse prognosis in patients with NMPE, with a 57% and 43% 1-year mortality rate, respectively. CONCLUSIONS This is the largest prospectively collected series in patients with NMPE, demonstrating that cases secondary to organ dysfunction have extremely high 1-year mortality. In addition, the presence of bilateral and transudative effusions is an indicator of increased mortality. Clinicians should be aware of these poor prognostic features and guide management accordingly.
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Affiliation(s)
- Steven P Walker
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England.
| | - Anna J Morley
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | - Louise Stadon
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | - Duneesha De Fonseka
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | - David T Arnold
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | | | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
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DeBiasi EM, Pisani MA, Murphy TE, Araujo K, Kookoolis A, Argento AC, Puchalski J. Mortality among patients with pleural effusion undergoing thoracentesis. Eur Respir J 2015; 46:495-502. [PMID: 25837039 DOI: 10.1183/09031936.00217114] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/24/2015] [Indexed: 01/16/2023]
Abstract
Of the 1.5 million people diagnosed with pleural effusion in the USA annually, ~178 000 undergo thoracentesis. While it is known that malignant pleural effusion portends a poor prognosis, mortality of patients with nonmalignant effusions has not been well studied.This prospective cohort study evaluated 308 patients undergoing thoracentesis. Chart review was performed to obtain baseline characteristics. The aetiology of the effusions was determined using standardised criteria. Mortality was determined at 30 days and 1 year.247 unilateral and 61 bilateral thoracenteses were performed. Malignant effusion had the highest 30-day (37%) and 1-year (77%) mortality. There was substantial patient 30-day and 1-year mortality with effusions due to multiple benign aetiologies (29% and 55%), congestive heart failure (22% and 53%), and renal failure (14% and 57%, respectively). Patients with bilateral, relative to unilateral, pleural effusion were associated with higher risk of death at 30 days and 1 year (17% versus 47% (hazard ratio (HR) 2.58, 95% CI 1.44-4.63) and 36% versus 69% (HR 2.32, 95% CI 1.55-3.48), respectively).Patients undergoing thoracentesis for pleural effusion have high short- and long-term mortality. Patients with malignant effusion had the highest mortality followed by multiple benign aetiologies, congestive heart failure and renal failure. Bilateral pleural effusion is distinctly associated with high mortality.
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Affiliation(s)
- Erin M DeBiasi
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA
| | - Margaret A Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA
| | - Terrence E Murphy
- Claude D. Pepper Older Americans Independence Center at Yale, Program on Aging, New Haven, CT, USA
| | - Katy Araujo
- Claude D. Pepper Older Americans Independence Center at Yale, Program on Aging, New Haven, CT, USA
| | - Anna Kookoolis
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA
| | - A Christine Argento
- Division of Pulmonary and Critical Care Medicine, Emory University, Atlanta, GA, USA
| | - Jonathan Puchalski
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA
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Potechin R, Amjadi K, Srour N. Indwelling pleural catheters for pleural effusions associated with end-stage renal disease: a case series. Ther Adv Respir Dis 2014; 9:22-7. [DOI: 10.1177/1753465814565353] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Pleural effusions are a common complication of end-stage renal disease. These effusions are occasionally refractory to medical management, but few options are then available. Indwelling pleural catheter insertion (IPC) has been well described for the management of malignant pleural effusions and, more recently, of nonmalignant effusions of other origin. We aimed to analyze our experience and to evaluate the safety and feasibility of using IPCs for pleural effusion associated with end-stage renal disease. Methods: We constructed a cohort of patients who underwent IPC insertion for pleural effusions associated with end-stage renal disease. The IPCs were inserted as a palliative measure in patients who had thoracentesis twice within the preceding 2 weeks, no evidence of infection and either failure to respond, complications or intolerance to maximal medical therapy, or if IPC insertion would enable discharge when the patient was hospitalized mainly for dyspnea due to pleural effusion. Results: There were nine IPCs inserted in eight patients. Patients had significant dyspnea at baseline with a median baseline dyspnea index of 1.5 [interquartile range (IQR) 0–3]. Dyspnea improved significantly 2 weeks after catheter insertion with a median transitional dyspnea index of 6 (IQR 4.5–7.0). There was no occurrence of empyema or other major complications. Serum albumin did not decrease after catheter insertion. IPCs were removed in four patients (50%) and successful spontaneous pleurodesis occurred in three patients (37.5%) after a median of 77 days (IQR 9–208). Conclusion: IPC insertion for pleural effusions associated with end-stage renal disease appears safe and effective. Larger studies are needed, particularly regarding the impact of this intervention on quality of life.
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Affiliation(s)
- Rajini Potechin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada and Department of Medicine, Ottawa Hospital, Ottawa, ON, Canada
| | - Kayvan Amjadi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada and Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nadim Srour
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Mount Sinai Hospital Centre, Montreal, Quebec, Canada and the Ottawa Hospital Research Institute, Ottawa, Canada; Hôpital Charles-LeMoyne, 3120 Boulevard Taschereau, Greenfield Park, QC, J4V 2H1, Canada
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