A 58-year-old man with a body surface area of 2.02 m_ with ischaemic heart disease and chronic renal failure secondary to nephroangiosclerosis. Informed about dialysis techniques, he opted for PD as he wanted home treatment. On 23-Jan-2004, a self-positioning PD catheter was surgically implanted without incident. A preoperative chest X-ray showed no pleural effusion or other notable alterations.

On 30-March-2004 continuous ambulatory PD (CAPD) was started with 3 daily exchanges of 2,000 cc at 1.36%. After 48 hours, the patient reported drainage of 2,500 cc after 8 h. of stay, and so the pattern was modified to 2 daily exchanges with the same volume and glucose to minimise the negative effect of excessive ultrafiltration on residual renal function (RRF). After 1 week on CAPD, on 6-April-2004 he consulted for medium effort dyspnoea with orthopnoea of 48 hours' evolution. He had abundant diuresis, drainage of 2,300-2,400 cc per exchange and stable weight. Examination revealed a decrease in vesicular murmur in the right lung base, compatible with the existence of pleural effusion at that level, which was confirmed by a chest X-ray.
With a diagnosis of suspected hydrothorax on CAPD, diagnostic thoracentesis was performed on the right, which showed a clear yellow fluid with protein < 1 g/dl, 17 leu/mm3, 40 haem/mm3 and 197 mg/dl glucose for a glycaemia of 108 mg/dl. Upon diagnostic confirmation of hydrothorax, CAPD was discontinued and the patient was kept on an outpatient basis without dialysis due to his good RRF. Symptoms improved the following day and a check-up a week later showed no pleural effusion.
On 20-April-2004, after 2 weeks without PD, the patient was admitted and CAPD was restarted in decubitus with 6 exchanges/day of 1,000 cc at 1.36% to minimise intraperitoneal pressure, without initial recurrence of the hydrothorax. After 4 days without problems, the infusion volume was increased to 1,500 cc and ambulation was allowed. On 27-April-2004 he was discharged. After 3 days at home and 10 days after restarting CAPD, he returned to the hospital with a recurrence of the right hydrothorax. On this occasion, and after immediate discontinuation of CAPD, a haemodialysis (HD) catheter was implanted in the right femoral vein. The good evolution of the case during the first few days after restarting CAPD encouraged us to try again to solve the problem by means of peritoneal rest, this time for a longer period of time.
On 31-May-2004, after a month of peritoneal rest, he restarted CAPD again with 5 daily exchanges of 1,000 cc at 1.36% and absolute bed rest, this time with a recurrence of hydrothorax only 48 hours later. CAPD was again suspended and HD was restarted. Given the ineffectiveness of conservative treatment, and in agreement with the patient, pleurodesis with talc was indicated, which the thoracic surgeons performed on 18 June 2004 with no further incidents or problems. A chest X-ray taken 4 days after thoracentesis showed no pleural effusion. After keeping the patient on HD for a further 5 weeks as recommended by the thoracic surgeons, on 26 July 2004, CAPD was restarted with 4 exchanges/day of 1500 cc at 1.36%, this time without incident. Currently, 15 months after restarting CAPD after pleurodesis, the patient is still on CAPD with no recurrence of the hydrothorax, using 4 exchanges/day of 2 litres at 1.36% and is really satisfied to be able to remain on the type of dialysis he had chosen.