Abstract: 【Abstract】Objective To explore the clinical features, diagnosis and treatment of pleuroperitoneal communication in peritoneal dialysis (PD) patients. Methods The PD patients diagnosed with pleuroperitoneal communication during January 1, 2006 to September 30, 2021 and treated in the PD Center of Peking University People's Hospital were enrolled in this study. General information, PD procedures, symptoms and signs, laboratory results, diagnosis methods, treatment and outcome were collected and analyzed. Results ①Five PD patients with pleuroperitoneal communication were diagnosed with the incidence of 0.96%. ②Pleuroperitoneal communication occurred in the period of increasing dialysate dwelling dose during the first 3~13 weeks of PD and at the right side in all of the 5 cases. Four of the five cases were females. Female, older age and low body surface area may be the risk factors. The major clinical manifestations included chest tightness, dyspnea and decreased ultrafiltration volume. ③ Chest X-ray revealed moderate to large pleural effusion in right side. Glucose concentration in pleural fluid higher than that in blood, methylene blue injected into abdominal cavity, and CT peritoneography were the methods to confirm the diagnosis. ④Once diagnosed, PD should be interrupted immediately and changed to hemodialysis temporarily or permanently. In some cases, PD may be continued beginning from lower dialysate dwelling dose and gradual increase of the dose to reconstitute the long- term PD. Conclusions Pleuroperitoneal communication is a rare complication of PD, frequently occurring in the period of increasing dialysate dwelling dose at the early stage of PD. CT peritoneography has been the most simple and effective diagnosis method. After diagnosis, PD should be switched to hemodialysis temporarily or permanently, or reconstituted starting from lower dialysate dwelling dose and gradual increase of the dose. If possible, surgical treatment is an effective measure for this complication. To prevent the occurrence of pleuroperitoneal communication in PD patients with the risk factors, symptoms and signs relating to pleuroperitoneal communication and changes of intraperitoneal pressure should be closely monitored in the period of increasing dialysate dose at the early stage of PD, and the dialysate dwelling dose should be reduced when necessary.

Key words: Peritoneal dialysis, Pleuroperitoneal communication, Hydrothorax, CT peritoneography