Abstract
Background: Previous case studies have reported reversal of
acute renal failure after pericardiocentesis in pericardial effusion.
This study examines the effects of pericardiocentesis on pre-procedural
low cardiac output and acute renal dysfunction in patients with
pericardial effusion. Methods: This is a retrospective study of
95 patients undergoing pericardiocentesis between 2015 and 2020. Pre-
and post-procedure transthoracic echocardiograms (TTE) were reviewed for
evidence of cardiac tamponade, resolution of pericardial effusion, and
for estimation of right atrial (RA) pressure and cardiac output.
Laboratory values were compared at presentation and post-procedure.
Patients on active renal replacement therapy were excluded.
Results: Ninety-five patients were included for analysis (mean
age 62.2±17.8 years, 58% male). There was a significant increase in
glomerular filtration rate pre- and post-procedure. Fifty-six patients
(58.9%) had an improvement in glomerular filtration rate after
pericardiocentesis (termed “responders”), and these patients had a
lower pre-procedure glomerular filtration rate than “non-responders”.
Forty-four patients (46.3%) had a greater than 10% improvement in
glomerular filtration rate. There was a significant improvement in
estimated cardiac output and right atrial pressure for patients in both
groups. Patients who had an improvement in renal function had
significantly lower pre-procedural diastolic blood pressure and mean
arterial pressure. Conclusions: Pericardial drainage may
improve effusion-mediated acute renal dysfunction by reducing right
atrial pressure and thus systemic venous congestion, and by increasing
forward stroke volume and perfusion pressure.