Postpartum Cardiomyopathy After Successful Gestation in A Chronic Hemodialysis Patient: A Case Report Peritoneal Dialysis/Kronik Hemodiyaliz Programında Olan Hastada Başarılı Gebelik Sonrası Gelişen Postpartum Kardiyomiyopati: Olgu Sunumu

Yıl 2026, Cilt: 21 Sayı: 1, 56 - 62, 31.01.2026

Meryem Timucin , Anıl Şahin , Ferhan Candan

https://doi.org/10.47565/ndthdt.2026.124

Öz

Pregnancy is seen very rarely in patients undergoing routine dialysis program due to chronic renal insufficiency. Although successful pregnancies have been described, high complication ratios are present for both the mother and the fetus. In the recent years, due to the developments in dialysis methods, improvements in patient follow-up and multidisciplinary patient approaches, there were increases in fertilization probability and postconceptional live birth rates in this patient group. Pregnant hemodialysis patients are under a high risk of cardiac comorbidity. Gestational hypertension, preeclampsia and hypervolemia consist a high risk in hemodialysis patients with regards to the mother, however, no guideline related to the screening of cardiovascular functions of these patients is present. In this article, we investigated a hemodialysis patient with successful gestation and birth yet developed postpartum cardiomyopathy.

Anahtar Kelimeler

Pregnancy , Hemodialysis , Chronic Renal Disease , Postpartum Cardiomyopathy

Kronik Hemodiyaliz Programında Olan Hastada Başarılı Gebelik Sonrası Gelişen Postpartum Kardiyomiyopati: Olgu Sunumu/Postpartum Cardiomyopathy After Successful Gestation in A Chronic Hemodialysis Patient: A Case ReportPeritoneal Dialysis

Öz

Kronik böbrek yetmezliği nedeniyle rutin diyaliz programında olan hastalarda nadiren gebelik görülebilmektedir. Başarılı gebelikler tarif edilmiş olsa da hem anne hem de fetüs için yüksek komplikasyon oranları mevcuttur. Son yıllarda diyaliz yöntemlerindeki gelişmeler, hasta takibindeki iyileşmeler ve multidisipliner hasta yaklaşımları nedeniyle bu hasta grubunda da fertilizasyon olasılığı ve gebelik sonrası canlı doğum oranlarında artışlar olmuştur. Gebe hemodiyaliz hastaları yüksek kardiyak komorbiditeye sahiptir. Gebelikle ilişkili hipertansiyon, preeklampsi ve hipervolemi hemodiyaliz hastalarında anne açısından yüksek bir risk taşımaktadır, ancak bu hastaların kardiyovasküler fonksiyonlarının izlenmesine ilişkin herhangi bir kılavuz mevcut değildir. Biz burada başarılı bir gebelik ve doğum gerçekleşen ancak postpartum kardiyomiyopati gelişen hemodiyaliz hastası bir olguyu inceledik.

Anahtar Kelimeler

Gebelik , Hemodiyaliz , Kronik Böbrek Yetmezliği , Postpartum Kardiyomiyopati

Kaynakça

• 1. Holley JL. The hypothalamic-pituitary axis in men and women with chronic kidney disease. Adv Chronic Kidney Dis. 2004;11(4):337-41. https://doi.org/10.1053/j. ackd.2004.07.004.
• 2. Hou SH. Frequency and outcome of pregnancy in women on dialysis. Am J Kidney Dis. 1994;23(1):60-3. https://doi.org/10.1016/S0272-6386(12)80813-4.
• 3. Holley JL, Reddy SS. Pregnancy in dialysis patients: A review of outcomes, complications and management. Semin Dial. 2003;16:384-7. https://doi.org/10.1046/j.1525-139x.2003.16085.x
• 4. Gitaras I, Levy DP, Malone FD, Carlson JA, Jungers P. Pregnancy during dialysis: Case report and management guidelines. Nephrol Dial Transplant. 1998;13:3266-72. https://doi.org/10.1093/ndt/13.12.3266
• 5. Confortini P, Galanti G, Ancona G, Giongio A, Bruschi E, Lorenzini E. Full term pregnancy and successful delivery in a patient on chronic hemodialysis. Proc Eur Dial Transplant Assoc. 1971;8:74-80. [Internet] 1971 [cited: 28.01.2026] Available from: https://cir.nii.ac.jp/crid/1573668924084105856
• 6. Vidaeff AC, Yeomans ER, Ramin SM. Pregnancy in women with renal disease. Part I: general principles. Am J Perinatol. 2008;25:385-97. https://doi.org/doi:10.1055/s-0028-1083837.
• 7. Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ. 2008;26:336(7637):211-5. https://doi.org/10.1136/bmj.39406.652986. BE.
• 8. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9 Suppl 3:S1-155. https://doi.org/10.1111/j.1600-6143.2009.02834.x.
• 9. Souqiyyeh MZ, Huraib SO, Saleh AG, Aswad S. Pregnancy in chronic hemodialysis patients in the Kingdom of Saudi Arabia. Am J Kidney Dis. 1992;19(3):235-8. https://doi.org/10.1016/S0272-6386(13)80003-0.
• 10. Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis. 1998;31(5):756-65. https://doi.org/10.1016/S0272-6386(98)70060-5
• 11. Manisco G, Potì' M, Maggiulli G, Di Tullio M, Losappio V, Vernaglione L. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery. Clin Kidney J. 2015;8(3):293-9. https://doi.org/10.1093/ckj/sfv016
• 12. Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. Am J Kidney Dis. 1998;31(5):766-73. https://doi.org/10.1016/S0272-6386(98)70044-7.
• 13. Luders C, Castro MCM, Titan SM, De Castro I, Elias RM, Abensur H, et al. Obstetric outcome in pregnant women on long-term dialysis: a case series. Am J Kidney Dis. 2010;56(1):77-85. https://doi.org/10.1053/ j. ajkd.2010.01.018
• 14. Perl J, Chan CT. Home hemodialysis, daily hemodialysis, and nocturnal hemodialysis: Core curriculum 2009. Am J Kidney Dis. 2009;54(6):1171-84. https://doi.org/10.1053/j. ajkd.2009.06.038.
• 15. Yasin SY, Bey Doun SN. Hemodialysis in pregnancy. Obstet Gynecol Surv. 1988;43(11):655-8. https://doi.org/10.1097/00006254-198811000-00004.
• 16. Krane NK, Hamrahian M. Pregnancy: kidney diseases and hypertension. Am J Kidney Dis. 2007;49(2):336-45.https://doi.org/10.1053/j. ajkd.2006.10.029.
• 17. Haase M, Morgera S, Bamberg C, Halle H, Martini S, Hocher B, et al. A systematic approach to managing pregnant dialysis patients-the importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant. 2005;20(11):2537-42.https://doi.org/10.1093/ndt/gfi174
• 18. Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis. 1999;33(2):235-52.https://doi.org/10.1016/S0272-6386(99)70296-9.
• 19. Kobayashi H, Matsumoto Y, Otsubo O, Otsubo K, Naito T. Successful pregnancy in a patient undergoing chronic hemodialysis. Obstet Gynecol. 1981;57:382.
• 20. Nakabayashi M, Adachi T, Itoh S, Kobayashi M, Mishina J, Nishida H. Perinatal and infant outcome of pregnant patients undergoing chronic hemodialysis. Am J Perinatol. 1999;16(4):195-200. https://doi.org/10.1159/000045364.
• 21. Egan DJ, Bisanzo MC, Hutson HR. Emergency department evaluation and management of peripartum cardiomyopathy. J Emerg Med. 2008;35(2):155-60. https://doi.org/10.1016/j.jemermed.2007.04.006.
• 22. Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation. 1971;44(5):964-8. https://doi.org/10.1161/01.cir.44.5.964.
• 23. Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000;283(9):1183-8. https://doi.org/10.1001/jama.283.9.1183.
• 24. McGregor AJ, Barron R, Rosene-Montella K. The pregnant heart: cardiac emergencies during pregnancy. Am J Emerg Med. 2015;33(7):927-32. https://doi.org/10.1016/ j. ajem.2015.02.046.
• 25. Scardovi AB, De Maria R, Ricci R. Acute peripartum cardiomyopathy rapidly evolving in cardiogenic shock. Int J Cardiol. 2015;191:310-2. https://doi.org/10.1016/j.ijcard.2015.03.364.
• 26. Givertz MM. Peripartum cardiomyopathy. Circulation. 2013;127(20):e622-6. https://doi.org/10.1161/CIRCULATIONAHA.113.001851.
• 27. Felker GM, Jaeger CJ, Klodas E, Thiemann DR, Hare JM, et al. Myocarditis and long-term survival in peripartum cardiomyopathy. Am Heart J. 2000;140(5):785-91. https://doi.org/10.1067/mhj.2000.110091.
• 28. Hilfiker-Kleiner D, Kaminski K, Podewski E, Bonda T, Schaefer A, Sliwa K, et al. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell. 2007;128(3):589-600. https://doi.org/10.1016/j.cell.2006.12.036
• 29. Sliwa K, Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Becker A, et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation. 2010;121(13):1465-73. https://doi.org/10.1161/CIRCULATIONAHA.109.901496.
• 30. Heider AL, Kuller JA, Strauss RA, Wells SR. Peripartum cardiomyopathy: a review of the literature. Obstet Gynecol Surv. 1999;54(8):526-31. https://doi.org/10.1097/00006254-199908000-00023.