—Dr Minuth suggests that conservative treatment (intensified dialysis with or without indomethacin) is safe for patients undergoing maintenance hemodialysis in whom pericarditis with substantial effusion develops. We believe otherwise. The high success rate of conservative management in many reports may be related to the inclusion of patients in whom the risk of tamponade is low (eg, patients without effusion or with small effusions,1 and patients receiving maintenance peritoneal dialysis2). Such reports may also include patients (with or without effusion) who had never received dialysis,3 in whom the response rate to dialysis is high.4 Our recent editorial concerns only patients already receiving maintenance hemodialysis in whom pericarditis with substantial pericardial effusion develops. This subgroup fares poorly with conservative treatment. For example, Luft et al1 studied 15 patients undergoing chronic hemodialysis in whom pericarditis developed. Six of these patients had moderate to large pericardial effusions.