Improvement in Renal Function and Cardiac Hemodynamics after Pericardiocentesis: A Retrospective Analysis.

Introduction: Fluid accumulation between the visceral and parietal pericardium can lead to cardiac tamponade, impaired ventricular filling, decreased cardiac output and eventual multiorgan failure. 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 echocardiographic signs for cardiac tamponade, resolution of pericardial effusion, and for estimation of right atrial (RA) pressure and cardiac output. Laboratory values were compared at presentation and within 24-48 hours 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 decrease in average serum creatinine pre- and post-procedure (p=0.0002). Fifty-six patients (58.9%) had an improvement in serum creatinine after pericardiocentesis (termed “responders”), and these patients had a higher pre-procedure serum creatinine than “non-responders” (p=0.022). There was a significant improvement in estimated cardiac output and RA pressure for patients in both groups that was independent of improvement in renal function. Creatinine “responders” had a significantly lower pre-procedure diastolic blood pressure and mean arterial pressure (MAP).

Conclusion: Pericardiocentesis in the setting of echocardiographic tamponade may improve acute renal dysfunction, RA pressure, and forward stroke volume. Improvements in serum creatinine were independent of improvements in RA pressure and forward stroke volume, indicating that improvement in renal function was likely related to increased susceptibility to renal injury from altered hemodynamic, hormonal and sympathetic activity.