Recently, the number of patients being treated by continuous ambulatory peritoneal dialysis (CAPD) has been gradually increasing. The most common and important complication of CAPD is infection, e.g., acute bacterial peritonitis and subcutaneous pericatheter infection. We experienced a case complicated by massive pleural effusion in the initial phase of institution. Although pleural effusion is a rare complication of the CAPD, this condition is extremely important because continuation of treatment is relatively ineffective. According to the literature, 43 patients with the same complication have been reported. Almost half of the cases complicated by pleural effusion were switched to chronic hemodialysis due to the difficulty of treatment. On the other hand, 8 cases were able to continue on CAPD after conservative treatment alone, such as decreasing dialysate volume or temporary discontinuation of CAPD. These facts indicate that the etiology of the massive pleural effusion during CAPD was not single. CAPD is a very useful system for managing end-stage renal failure, and pleural effusion cannot be detected before the institution of CAPD. Therefore, cases complicated by pleural effusion must be examined to determine whether CAPD can be continued or not.