The development of pleural effusions in ESRD patients is a relatively common occurrence. Uremia, currently a rare cause of effusion, can lead to the development of hemorrhagic pleural fluid collections in patients who are underdialyzed. Uremic pleural effusions should be considered when common etiologies of effusions such as volume overload, congestive heart failure (CHF), infection, and malignancy have been excluded. Uremia-associated serosal injury allows transudation of fluid into the pleural space, and defective platelet function contributes to the hemorrhagic nature of the effusion. Although uremic effusions may occur less frequently in peritoneal dialysis patients, we present a patient who developed this complication due to a peritoneal dialysis regimen that was inadequate by current Dialysis Outcomes Quality Initiative guidelines. The pleural effusion resolved with an intensified dialysis regimen in the absence of a change in the underlying volume status.
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