Difficulties in the determination of target dry weight in hemodialysis during the third trimester of pregnancy

Abstract

BACKGROUND: Pregnancies in women with chronic renal disease undergoing hemodialysis are rare but are increasingly observed. Estimation of the appropriate dry weight for pregnant women on hemodialysis is very difficult. METHODS: We report a successful pregnancy in a hemodialysis patient; however, this patient did develop transient congestive heart failure during the third trimester. RESULTS: Both mother and fetus made stable progress until the third trimester. The patient was admitted to our hospital after 33 weeks of pregnancy, and her target dry weight was gradually increased from 61.0 to 61.5 kg over a week to adjust for pregnancy-induced weight gain. She then developed symptoms of congestive heart failure, and her cardiotocograph data worsened. The symptoms quickly disappeared when her dry weight was reduced, and she successfully gave birth to a baby the following week. Her clinical course may have reflected the need for maximum maternal plasma expansion in the third trimester opposed by vascular stiffness induced by chronic kidney disease. CONCLUSION: Our experience with this patient suggests that care is required in setting an appropriate target dry weight in the late phase of pregnancy.