A Case of ‘Sweet’ Hydrothorax in a Patient on Peritoneal Dialysis

Non-infectious complications are an important cause of peritoneal dialysis failure. Increased intra-abdominal pressure resulting from dialysate inflow into the peritoneal cavity can cause leaks, including hydrothorax due to pleuroperitoneal communication. The authors describe a patient on peritoneal dialysis with a newly discovered pleural effusion with a high glucose level. The patient was treated conservatively with peritoneal dialysis cessation and switched to haemodialysis with complete resolution of the pleural effusion. After 5 weeks, the patient successfully restarted peritoneal dialysis without recurrence of the hydrothorax. LEARNING POINTS: Pleural effusion in a patient on peritoneal dialysis can be caused by leakage of dialysate through pleuroperitoneal communication. Pleural effusion as a result of dialysate leak is rich in glucose. If conservative treatment with temporary peritoneal dialysis cessation is unsuccessful, any pleuroperitoneal communication should be surgically repaired.