Hemodialysis patient with worsening heart failure due to pregnancy： A case report

Abstract

At 7 years of age, the patient received peritoneal dialysis for end‒stage renal failure caused by interstitial nephritis. Subsequently, she underwent renal transplantation with her mother as the donor, and started hemodialysis at 29 years of age. At 35 years of age, the patient became pregnant spontaneously, and had been undergoing hemodialysis (HD) five times weekly since then. At 14 weeks of gestation, she developed dyspnea and was admitted to the hospital with an echocardiogram showing an ejection fraction (EF) of 40％ and heart failure. The symptoms improved with hemodialysis conducted six times weekly and a dry weight (DW) reduction of 200 g. Thereafter, DW changed by＋0.4 kg/week, noted while evaluating the cardiac function. At 22 weeks of gestation, the patient again developed heart failure and was urgently hospitalized with a markedly decreased EF of 20％. After confirming that there were no problems with fetal growth or the amniotic fluid volume, and DW was stable, an emergency cesarean section was performed at 24 weeks of gestation. The fetus weighed 512 g, with 1‒ and 5‒minute Apgar Scores of 5 and 7 points, respectively. After delivery, there was no worsening of heart failure, she was changed to receiving dialysis three times weekly, and discharged on postoperative day 10.