Chest pain in the dialysis patient

Acute pericarditis is common in patients with end-stage renal disease. In these patients, the condition has been classified as uremic- and dialysis- associated pericarditis Diagnosis of pericarditis usually is based on a new pericardial friction rub with or without evidence of an effusion on transthoracic echocardiogram (TTE). A patient may present with changes on electrocardiogram and chest radiograph. Of note, the S-T segment elevations classically seen in acute pericarditis are rare in uremic pericarditis patients. These diagnostic study results, along with clinical status, guide patient management. Treatment consists of intensive hemodialysis, surgery, and pericardiocentesis. Patients should be followed up with serial TTEs.