RESUMO
The purpose of this paper is to describe the risks of ventriculopleural shunt in patients with spina bifida and end-stage-renal-diseases (ESRD), and to describe endoscopic third ventriculostomy as an alternative for the combination of cerebrospinal shunt and dialysis modality. We report a 16-year-old boy with spina bifida on chronic dialysis with a massive unilateral hydrothorax and respiratory distress complicating a ventriculopleural (VPL) shunt. Two thoracocenteses were performed, draining 3200 ml of a clear fluid. The VPL shunt was removed and revised successfully to a third ventriculostomy (TVE). Peritoneal dialysis (PD) was the initial dialysis modality. After 12 months on PD, the patient was transferred to hemodialysis (HD) because of refractory peritonitis. Hydrothorax developed while the patient was on PD, reaching its maximum 2 months after the transference to HD. To our knowledge there has been no other report of ventriculopleural (VPL) shunt failure, and endoscopic TVE, as a cerebrospinal fluid (CSF) diversion alternative in patients on chronic dialysis.
Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Hidrotórax/etiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Disrafismo Espinal/epidemiologia , Disrafismo Espinal/terapia , Terceiro Ventrículo/cirurgia , Ventriculostomia , Adolescente , Derivações do Líquido Cefalorraquidiano/métodos , Humanos , Hidrotórax/cirurgia , MasculinoRESUMO
In this study we analyze the impact of the patient's socioeconomic status (SES) and the distance from the patient's home to the dialysis center (DPH-DC), classified as < or =300 km or >300 km, on the patient and technique survival of 59 patients starting chronic peritoneal dialysis (CPD) between May 1983 and January 2004 at a single center in Uruguay. SES was established using Graffar's method. Mean duration of CPD was 38.1+/-26.0 months. Mean age at the start of CPD was 8.4+/-5.2 years. Overall patient and technique survival at 5 years were 86.4% and 77.9%, respectively. Twenty (33.8%) patients were transferred to hemodialysis. Eight (13.5%) patients died. The incidence of peritonitis was one episode every 9.1 months. There was no statistically significant difference in patient and technique survival between the patients in the low and high SES groups (p=0.72 and 0.99, respectively), and between those in the two DPH-DC groups, (p=0.22 and p=0.99, respectively). Logistic regression analysis confirmed low SES and DPH-DC >300 km are not predictors of patient death (p=0.79 and p=0.09, respectively) or technical failure (p=0.35 and p=0.15, respectively). No SES- and DPH-DC-related statistically significant differences were found in patient and technique survival.