Personalized dialysis: use of ultrasonography as a guide for ultrafiltration in hemodialysis during pregnancy. Case report

Objective: Present the use of ultrasound as a strategy that, together with clinical findings, can guide the use of renal replacement therapy. It also presents images that approximate the vascular pattern present in the vena cava, portal vein, and suprahepatic vein a pregnant woman. The renal vein was not considered due to changes associated with pregnancy that affect its measurement. Materials and methods: A woman with chronic kidney disease who required renal replacement therapy during pregnancy. Ultrasound monitoring of venous congestion at week 25 was used to guide the ultrafiltrate dose, along with clinical findings. With this approach, the patient presented placental abruption at week 32, and an emergency cesarean section was performed without complications. A fresh 1545 g new born was born. Both patients progressed satisfactorily. The patient continues on hemodialysis. Conclusions: Bedside ultrasound could be a useful tool to guide the ultrafiltration dose for hemodialysis in pregnant women requiring renal replacement therapy. Further studies are needed to standardize and provide recommendations for this specific population.