A case of a hemodialysis patient who showed congestive heart failure due to peripartum cardiomyopathy during her pregnancy

Abstract

Key words：hemodialysis, pregnancy, congestive heart failure, peripartum cardiomyopathy 〈Abstract〉 A 38-year-old woman on maintenance hemodialysis for 16 years due to IgA nephropathy was admitted to our hospital from 20 weeks of gestation in order to manage her pregnancy. After admission, we started 4 hours of ／ hemodialysis six times per week to maintain pre-dialysis BUN＜50 mg／dL and increased her dry weight by 200-300 g per week to match the growth of the fetus. Although we assessed the change of circulation blood volume(％BV) estimated by optical hematocrit measurements, the diameter of the inferior vena cava(IVCd), human atrial natriuretic peptide(hANP)and amniotic fluid volume, hANP increased gradually from 28 weeks of gestation. In the evening of 33 weeks 3 days of gestation, acute dyspnea suddenly occurred and we diagnosed congestive heart failure by chest X-ray and echocardiography. Then, urgent caesarean section was performed. She was