Clinical Course and Considerations of a Stage G4 Chronic Kidney Disease Patient Who Successfully Initiated Dialysis During Pregnancy and Discontinued It Postpartum.

BACKGROUND Pregnancy in patients with advanced chronic kidney disease (CKD) carries a high risk of complications, including preterm birth, the need for dialysis, and adverse maternal-fetal outcomes. Miscarriage is also relatively common in dialysis patients. However, there are no established guidelines regarding dialysis initiation or fluid management in pregnant women with renal failure. CASE REPORT A 41-year-old Japanese woman had been diagnosed with IgA nephropathy at age 17 following abnormal urinalysis, but subsequently discontinued medical follow-up. Later, she became pregnant and was diagnosed with CKD stage G4 at 6 weeks of gestation (estimated glomerular filtration rate: 28.2 mL/min/1.73 m²). Despite being informed of her high-risk status, she strongly wished to continue the pregnancy. Management included salt restriction, antihypertensive therapy, and close monitoring. At 31 weeks, worsening renal function and hypertension prompted the initiation of hemodialysis. Body fluid status was assessed using bioelectrical impedance analysis and the amniotic fluid index. Dialysis parameters were adjusted to avoid fetal compromise. Vaginal delivery occurred at 36 weeks. Hemodialysis was discontinued on postpartum day 6 following improvement in renal function, and both mother and infant were discharged without complications. CONCLUSIONS This case illustrates that individualized fluid control and close inpatient monitoring can enable both the continuation of pregnancy and successful dialysis withdrawal in patients with advanced CKD. Body composition monitoring may serve as a useful tool for managing fluid balance during pregnancy-related dialysis. This report contributes to the limited literature on dynamic dialysis decision-making in pregnant CKD patients.