How do you clinically distinguish between pericardial effusion from volume overload versus uremic pericarditis in advanced CKD?

Would you start hemodialysis in a patient with CKD Stage 5 and a moderate to large pericardial effusion, an unrevealing workup, a stable BUN in the 70s, and no uremic symptoms or other indications to start dialysis?

• No, I would defer dialysis initiation due the absence of clear uremic symptoms
• Yes, I would initiate dialysis since the pericardial effusion could be the result of uremic pericarditis
• Other