# Successful transition from long-term peritoneal dialysis to intermittent hemodialysis in a patient with Fontan circulation

## TL;DR

A patient with Fontan circulation successfully transitioned from peritoneal dialysis to hemodialysis after careful evaluation and treatment of heart-related risks.

## Contribution

Demonstrates the feasibility of transitioning to hemodialysis in a Fontan patient with preserved cardiac function and high central venous pressure.

## Key findings

- The patient tolerated hemodialysis at 150 mL/min without hemodynamic instability.
- Transition to IHD was feasible after confirming cardiovascular stability via cardiac catheterization.
- Outpatient hemodialysis was maintained for 9 months without major complications.

## Abstract

The Fontan procedure is a palliative surgical technique used for complex congenital heart disease resulting in a functional single ventricle. Patients with Fontan circulation often exhibit elevated central venous pressure (CVP) and reduced cardiac output, which make intermittent hemodialysis (IHD) challenging. Between dialysis sessions, increased preload due to fluid accumulation may precipitate congestive heart failure, whereas excessive ultrafiltration can reduce preload and consequently compromise cardiac output. We report the case of a 23-year-old man with a single ventricle of left ventricular morphology who underwent a Fontan procedure at 2 years of age. He developed kidney failure secondary to bilateral hypoplastic kidneys and began peritoneal dialysis (PD) at 12 years of age. PD was continued for 9 years because IHD and kidney transplantation were contraindicated due to cardiac dysfunction with arrhythmia. He presented with a refractory exit-site infection, for which laparoscopic surgery revealed early-stage encapsulating peritoneal sclerosis. Cardiac catheterization revealed a CVP of 11–12 mmHg, and ventricular function was preserved. Based on these findings, transition to IHD was considered feasible. Permanent pacemaker implantation and insertion of a tunneled hemodialysis catheter were performed concurrently. IHD was initiated at a blood flow rate of 150 mL/min, which was well tolerated, with no episodes of hemodynamic instability observed. The patient has since been maintained on outpatient IHD for 9 months without major complications. This case demonstrates that IHD can be safely performed in selected patients with Fontan circulation, provided that careful preoperative hemodynamic assessment is undertaken to confirm adequate cardiovascular stability.