Hydrothorax in a patient receiving continuous ambulatory peritoneal dialysis: successful treatment with intermittent...

A 51-year-old woman had end-stage renal failure from polycystic kidney disease. Two years after she started receiving peritoneal dialysis, a large right pleural effusion developed in the patient that was secondary to a pleuroperitoneal connection as demonstrated by a radionuclide scan. The patient was switched from continuous ambulatory peritoneal dialysis (CAPD) to intermittent peritoneal dialysis (IPD) with resolution of the effusion that recurred when she was rechallenged with CAPD one month later. We believe the large ultrafiltrate volume of CAPD with prolonged dwelling times may have ruptured microscopic defects in the diaphragm due to increased abdominal pressure. With the smaller ultrafiltrate volume of IPD and the semisitting position, the patient was able to continue receiving peritoneal dialysis with resolution of the pleural effusion.