Pregnancy in dialysis patients is a major challenge to physicians involved in care, given the rarity of occurrence, complications involved and the distressing observation that < 50% of pregnancies in patients receiving conventional dialysis result in surviving infants . Outcomes in patients receiving nocturnal hemodialysis have been more encouraging, making accurate interpretation of beta HCG levels more important. Serum beta HCG levels should be interpreted with caution in dialysis patients as levels tend to be slightly elevated even in non-pregnant patients and can be erroneously interpreted as intact pregnancy in a non-pregnant patient or a non-viable pregnancy in a pregnant patient as in our case.HCG is secreted in small amounts by all cells , and since the hormone is largely excreted by the kidneys, its level can be elevated in dialysis patients even if not pregnant. In a study conducted by Schwarz et al., beta HCG levels were increased by 10-fold in two of the 19 non-pregnant women who were on dialysis with post-dialysis levels being significantly higher than pre-dialysis levels. This observation has an important implication in clinical practice when monitoring serial beta HCG levels (pre- or post-dialysis blood sample should be specified when results are reported). Further studies need to be conducted in pregnant dialysis patients as data are limited on pre- and post-dialysis values of HCG. Since serum beta HCG levels are not reliable in dialysis patients, pregnancy is normally confirmed by an ultrasound. Fetal cardiac activity can be first detected at 5.5–6 weeks and can be missed if imaging is done earlier. If a non-viable pregnancy is suspected in a dialysis patient early in the first trimester, the diagnosis should be confirmed by measuring serial beta HCG as it decreases in a non-viable pregnancy, albeit more slowly than in a woman with normal renal function. Maternal serum alpha-fetoprotein levels should be monitored simultaneously. The triple antigen test which is used for screening fetal abnormalities might not be reliable in dialysis patients . The patient reported in our case would have had a therapeutic abortion in her first trimester if not for the poorly controlled diabetes. Pregnancy in a dialysis patient might represent the last opportunity for child bearing and every effort should be made to ensure a successful outcome.Conflict of interest statement. None declared. References. Human chorionic gonadotropin (hCG) is a hormone produced by the placenta after implantation. The presence of hCG is detected in some pregnancy tests (HCG pregnancy strip tests).. hCG Information hCG is measured in milli-international units per milliliter (mIU/ml) There is a wide range of normal hCG levels and values and the values are different in blood serum or urine..