Recent publications containing the principles of management in pregnant women with end-stage chronic renal failure (CRF) undergoing hemodialysis (HD) are analyzed. Due to the advancement of renal replacement therapy (HD), there has been recently an increase in the fertility of these patients. There are considerations that may be contrasted with a negative attitude to the fact that the end-stage CRF patients on HD can carry a pregnancy. Daily HD during pregnancy has been found to be most relevant. Such pregnant women are shown to need an individual choice of a HD regimen. It is emphasized there is a need for frequent hemoglobin and packed cell volume tests, early diagnosis of preeclampsia and fetoplacental insufficiency, careful dietary monitoring, and extradialytic drug therapy in these patients. There is a general algorithm to follow up and treat pregnant women with end-stage CRF on HD is presented.