0391-3988/1122-04 $15.00/0 The International Journal of Artificial Organs / Vol. 30 / no. 12, 2007 / pp. 1122-1125 Successful pregnancy in a uremic patient treated with single needle hemodialysis M. FERRANNINI, G. VISCHINI, N. MIANI, E. STAFFOLANI, N. DI DANIELE Nephrology and Dialysis Unit, Tor Vergata University, Rome - Italy © Wichtig Editore, 2007 ABSTRACT: Background: Pregnancy is uncommon in patients on maintenance hemodialysis (HD) and it carries a high risk of fetal and maternal complications. Several reports have shown that appli- cation of an intensive dialysis regimen is associated with improved infant survival and better clinical conditions of the mother. Methods: We report the case of a 35-year-old black woman with a prosthesic cardiac valve who was treated daily with single needle HD because of difficult vascular access. Result: A healthy full-term female infant with a normal birth weight was electively delivered at 37 weeks. We did not register any complications during or after pregnancy. Conclusion: In our experience, single needle HD is able to provide the patient with adequate depura- tion during pregnancy, the delivery of a full-term healthy infant, and preservation of the arterial-ve- nous fistula from twice-daily vein puncture. (Int J Artif Organs 2007; 30: 1122-5) KEY WORDS: Pregnancy, Hemodialysis INTRODUCTION Pregnancy is a rare occurrence in women on dialysis. Several factors appear to contribute to this subinfertility, such as uremia or comorbidities related to chronic renal failure. Based on recently published cases and registry reports, the outcome of these patients has markedly im- proved, with 30% to 50% of pregnancies resulting in the delivery of a surviving infant (1-7). Nevertheless, fetal mortality in pregnant women on dialysis is still much higher than in the general population (8). Dialysis-related complications that impair the utero-placental circulation, with outcomes ranging from premature delivery to fetal death, may be summarized as polyhydramnios, maternal blood pressure instability, shifts in acute fluid volume, anemia and electrolyte imbalance. The complex and precarious condition of the pregnant woman on dialysis requires close collaboration between the patient, nephrologist, dialysis staff, obstetrician, and neonatologist to maximize the chance of a successful pregnancy. To date, no experience has been reported on the outcome, safety and efficiency of single needle he- modialysis (HD) in pregnant patients. We present our case of successful delivery at week 37 in a 35-year-old black woman treated with single needle dialysis because of a difficult proximal arterial-venous fistula (AVF). CASE REPORT A 35-year-old black woman with uremia was started on hemodialysis (3 times/week) eight years previously in 1999 for an IgA nephropathy. Her medical and surgical history was remarkable for two previous miscarriages, during dialysis therapy at another nephrological center, and an aortic valve substitution in 2004. Her domiciliary therapy consisted solely of acenocumarol. Her third pregnancy was diagnosed at 3 weeks of ges- tation from elevated β-hCG. Because of the history of miscarriage and the prosthesic valve, requiring home therapy with acenocumarol and traditional heparin during HD, a multidisciplinary nephrological, obstetric and car- diac surgery team was formed to achieve optimal mater- nal health and optimal fetal growth and development. Our goals were: a) to avoid hypotensive or hypertensive episodes during and between HD; b) to maintain pre-dial- Case Report