Uremic pericarditis, often with cardiac tamponade, is an infrequent but difficult problem, since the number of uremic patients kept alive by maintenance hemodialysis has increased. Some believe that aggressive dialysis with pericardiocentesis is the best therapy. Our experience suggests that this is not always adequate. Increasing experience indicating that uremic patients on hemodialysis tolerate major surgical procedures well has prompted an early and aggressive surgical approach when tamponade is not quickly relieved by conservative methods. Five patients on chronic hemodialysis developed pericarditis and tamponade after 1, 6, 7, 13 and 15 months of dialysis. All were subjected to a partial pericardectomy with the objectives of (1) eliminating the tamponade, and (2) preventing recurrence or constriction. All are alive and active from 6 to 23 months after the surgical procedure.
Ghavamian M, Gutch CF, Hughes RK, Kopp KF, Kolff WJ. Pericardial Tamponade in Chronic-Hemodialysis PatientsTreatment by Pericardectomy. Arch Intern Med. 1973;131(2):249–253. doi:10.1001/archinte.1973.00320080085011