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Background <p>Refractory pleural effusion occasionally occurs in patients undergoing maintenance hemodialysis and is associated with a poor prognosis. We recently encountered idiopathic refractory pleural effusion in two patients undergoing maintenance hemodialysis and obtained favorable outcomes with autologous blood pleurodesis. Herein, we report these two cases.</p> Case presentation <p>Case 1: An 82-year-old man started hemodialysis in May 2023 owing to chronic renal failure, which was presumed to have been caused by chronic glomerulonephritis. During the clinical course, he developed hepatic dysfunction related to autoimmune hepatitis. In June 2024, he presented with a massive right pleural effusion. At a public hospital, two pleurodesis procedures using talc and one using OK-432 were attempted, but none were successful. In July 2024, three pleurodesis procedures using 40&#xa0;mL of autologous blood were performed, ultimately resulting in successful pleurodesis. Case 2: A 77-year-old man started hemodialysis in November 2018 for renal failure related to diabetes mellitus. In December 2022, he was diagnosed with myelodysplastic syndrome. Around that time, he developed a left pleural effusion, which progressed to a massive pleural effusion by September 2024. In December 2024, three pleurodesis procedures using 40&#xa0;mL of autologous blood were performed, successfully achieving pleurodesis.</p> Conclusions <p>We reported two patients undergoing maintenance hemodialysis with idiopathic refractory pleural effusion who were successfully treated with autologous blood pleurodesis. No adverse events related to pleurodesis were observed in either case. Autologous blood pleurodesis is commonly performed for pneumothorax and was also effective for refractory pleural effusion in these cases. We conclude that autologous blood pleurodesis is a safe and effective treatment for refractory pleural effusion. To our knowledge, this is the first report to describe the efficacy and safety of autologous blood pleurodesis for idiopathic pleural effusion in patients undergoing hemodialysis.</p>

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Successful autologous blood pleurodesis in two maintenance hemodialysis patients with idiopathic refractory pleural effusion: case reports and literature review

  • 期刊论文

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  • 发表日期：

    2025年10月1日

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  • Ryoichi Miyazaki,
  • Kyoko Miyagi,
  • Tatsuhito Miyanaga,
  • Kazuhiko Igarashi,
  • Mitsuo Awaji

摘要

Background

Refractory pleural effusion occasionally occurs in patients undergoing maintenance hemodialysis and is associated with a poor prognosis. We recently encountered idiopathic refractory pleural effusion in two patients undergoing maintenance hemodialysis and obtained favorable outcomes with autologous blood pleurodesis. Herein, we report these two cases.

Case presentation

Case 1: An 82-year-old man started hemodialysis in May 2023 owing to chronic renal failure, which was presumed to have been caused by chronic glomerulonephritis. During the clinical course, he developed hepatic dysfunction related to autoimmune hepatitis. In June 2024, he presented with a massive right pleural effusion. At a public hospital, two pleurodesis procedures using talc and one using OK-432 were attempted, but none were successful. In July 2024, three pleurodesis procedures using 40 mL of autologous blood were performed, ultimately resulting in successful pleurodesis. Case 2: A 77-year-old man started hemodialysis in November 2018 for renal failure related to diabetes mellitus. In December 2022, he was diagnosed with myelodysplastic syndrome. Around that time, he developed a left pleural effusion, which progressed to a massive pleural effusion by September 2024. In December 2024, three pleurodesis procedures using 40 mL of autologous blood were performed, successfully achieving pleurodesis.

Conclusions

We reported two patients undergoing maintenance hemodialysis with idiopathic refractory pleural effusion who were successfully treated with autologous blood pleurodesis. No adverse events related to pleurodesis were observed in either case. Autologous blood pleurodesis is commonly performed for pneumothorax and was also effective for refractory pleural effusion in these cases. We conclude that autologous blood pleurodesis is a safe and effective treatment for refractory pleural effusion. To our knowledge, this is the first report to describe the efficacy and safety of autologous blood pleurodesis for idiopathic pleural effusion in patients undergoing hemodialysis.