Introduction: Pericarditis is a known cause of chest pain, particularly in young men. It may be complicated by cardiac tamponade, which requires urgent intervention. The aetiology of acute pericarditis may pose a diagnostic challenge. Possible causes include viral and bacterial infections, rheumatic diseases, aortic dissection, and others. Uremic pericarditis is also a potential cause, primarily occurring in dialysis patients, and less common in those with chronic kidney disease prior to initiating dialysis. Case report: A 65-year-old male patient was admitted to the hospital due to deterioration of general condition and dyspnoea. Based on the clinical presentation, cardiac tamponade secondary to pericarditis was suspected, which was confirmed by imaging studies. Emergency pericardiocentesis was performed. The differential diagnosis included uremic and viral aetiologies. Daily haemodialysis and corticosteroid therapy were initiated, resulting in clinical improvement. Discussion: Uremic pericarditis predominantly occurs in patients with chronic kidney disease and may develop both prior to and during dialysis, irrespective of serum urea levels. Intensified dialysis, as in the case described, frequently leads to clinical improvement. Pharmacological treatment for viral acute pericarditis has limited efficacy in patients with chronic kidney disease, making corticosteroid therapy the primary therapeutic option. Conclusion: In dialysis patients presenting with acute pericarditis, uremic aetiology, along with other potential causes, should always be considered. Early diagnosis and prompt pericardiocentesis are crucial in cases of cardiac tamponade.