Background <p>Serum beta-human chorionic gonadotropin is routinely measured as a pregnancy marker in women of reproductive age prior to diagnostic and therapeutic interventions. Although a positive result commonly indicates pregnancy, false-positive values may occur, particularly in women with chronic kidney disease due to impaired renal clearance.</p> Case presentation <p>We report the case of a 23-year-old Iranian woman with end-stage renal disease on hemodialysis who presented with persistently elevated serum beta-human chorionic gonadotropin during pretransplant evaluation, despite being sexually inactive. Further evaluation, including a negative urine human chorionic gonadotropin test and imaging studies, confirmed that she was not pregnant. The false-positive result caused significant delays in her eligibility for transplantation, resulting in nearly a month postponement of the procedure.</p> Conclusion <p>False-positive beta-human chorionic gonadotropin results are clinically significant in patients with end-stage renal disease and may delay urgent interventions such as kidney transplantation. Clinicians should interpret beta-human chorionic gonadotropin cautiously in this population and consider confirmatory testing—including urine beta-human chorionic gonadotropin assays, imaging, or serum progesterone measurement—before postponing time-sensitive procedures.</p>