Case Study: Pleuroperitoneal leakage is a complication of peritoneal dialysis. The passage of fluid facilitated, by increased intra-abdominal pressure, results in the loading of dialysis solution into the abdomen. An incidence ranging from 1.6 to 10% is reported in the literature and is a cause of drop-out from peritoneal dialysis. On 22/01/19 patient M.A. aged 80, Automated Peritoneal Dialysis(APD) since May 2017, performing accessing Geriatric Emergency Acceptance at INRCA hospital of Ancona for dyspnea and reported ultrafiltrate reduction. Chest X-ray with evidence of massive right pleural effusion and haemogas showing severe respiratory failure. On suspicion of pleuroperitoneal leakage, APD dialysis was suspended and haemodialysis started. On 30/01/19 we load in the abdomen of glucose 3.86% 2000 cc. After two hours 1000cc was discharged from abdomen and 1500cc of pleural fluid drained. Pleural fluid glucose assay resulted 1315 mg/dl with parallel blood glucose of 237 mg/dl: test was diagnostic for pleuroperitoneal leakage. On 12/02/20, scintigraphy was performed with radiolabeled albumin administered into the peritoneal cavity by dilution in a 2000cc bag. Scintigraphic images didn’t document passage of the radioisotope into the pleural spaces. Examination demonstrated spontaneous closure of the pleuroperitoneal fistula. The patient was discharged on 13/02/20. APD proposed again, but the patient chose to remain on haemodialysis. Our experience confirms that peritoneal pleural leakage is a complication of peritoneal dialysis. Diagnosis can be made by glucose gradient between blood and pleural fluid, injection of a radioisotope into the pleural cavity or by RM/CT. To date there is no clear evidence documenting the treatment of choice. A conservative or surgical approach is possible. In our case, spontaneous closure of the fistulous passage was achieved by limiting the increase in intra-abdominal pressure with interruption of APD. The maintenance of haemodialysis treatment after resolution of the leakage was only a personal choice of the patient.