A hemodialysis patient experienced worsening heart failure during pregnancy requiring close monitoring and management.
Case Report (n=1)
No
1 35-year-old pregnant woman with end-stage renal disease on maintenance hemodialysis who developed worsening heart failure (peripartum cardiomyopathy) during pregnancy.
Increased hemodialysis frequency (up to 6 times weekly) and strict dry weight reduction.
Improvement of heart failure symptoms and successful continuation of pregnancy.
Careful management of dry weight and increased hemodialysis frequency can successfully manage peripartum cardiomyopathy in pregnant women on maintenance hemodialysis.
間質性腎炎による末期腎不全にて7歳時に腹膜透析導入，同年に母親をドナーとした生体腎移植を受けたが29歳時に血液透析（hemodyalisys： HD）導入となった．35歳で自然妊娠が判明し，以降週5回のHDへ移行した．妊娠12週に呼吸困難が出現し，心エコーにてEjection Fraction（EF）40％と低下，また心不全所見を認め入院となった．週6回のHDおよびドライウェイト（dry weight： DW）を200 g下げることで症状が改善した．以降，心機能を評価しながらDWを＋0.4 kg/週で上方修正していった．妊娠22週に再度心不全を発症し緊急入院，EF 20％と著明な低下を認めた．DWを1.6 kg/週で下げることで心不全症状は改善した．胎児発育や羊水量に問題がないことを確認しながらDWは変更せず妊娠24週に緊急帝王切開術を施行した．胎児は体重512 gで娩出し，Apgar score 1分値5点/5分値7点であった．分娩後，心不全の増悪は認めず，週3回の透析へ移行し術後10日目に退院となった．
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Keisuke Hori
Yoshitaka Sekine
Gunma University
Yuki Morimura
Gunma University
Nihon Toseki Igakkai Zasshi
Gunma University
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Hori et al. (Thu,) conducted a case report in Pregnant female hemodialysis patient with worsening heart failure during pregnancy (n=1). A hemodialysis patient experienced worsening heart failure during pregnancy requiring close monitoring and management.
synapsesocial.com/papers/69a528ecf1e85e5c73bf065e — DOI: https://doi.org/10.4009/jsdt.59.55