A successful term pregnancy using in‐center intensive quotidian hemodialysis

Abstract

A 30-year-old woman with stage V chronic kidney disease presented at 7 weeks gestation. She had no uremic symptoms; however, blood urea nitrogen (BUN) was 33.6 mg/dL. Because of the well-established negative relationship between BUN and fetal outcomes, dialysis was initiated with a nocturnal home hemodialysis (NHD)-like prescription performed in-center for logistical reasons. She received 36 hours per week of dialysis. Following the initiation of renal replacement therapy, the predialysis BUN was within the normal physiologic range. The patient had an uncomplicated pregnancy with delivery of a healthy 3000 g infant at 39 weeks gestation. This case adds to the growing literature that supports more intensive dialysis in the pregnant women than was previously recommended. This dose of dialysis should be offered to women in an in-center setting if nocturnal home hemodialysis is not available or feasible.

Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD

“…Although prematurity is very likely, a large proportion do progress to a satisfactory duration. Other studies from the recent era report a median GA of 31-33 weeks (2,6,9,10,20), with superior GA in patients treated with nocturnal hemodialysis (16,18). Most infants born were of low BW (,2500 g), which correlated with prematurity, although a large proportion of babies were on or below the 10th centile of weight for GA. Our median BW was similar to that in other recent studies, which reported median or mean BW ranging from 1483 to 1765 g (6)(7)(8)(9)(10)20), but it remains substantially less than the mean BW (6 SD) of 2417.56657 g reported in pregnancies managed with nocturnal hemodialysis (16).…”

“…Factors crucial to successful pregnancy outcome include increased dialysis delivery to optimize biochemical measures, particularly urea (6)(7)(8)(9)(10)(11)(12)16,18), control of hypertension, correction of anemia (7,15), close fetal monitoring (8,10), and a multidisciplinary approach to patient care (2,3,8). An important limitation of ANZDATA data are limited detail regarding such individual patient care, which would assist in further interpreting the differing outcomes observed in our cohort.…”

“…Conception rates in women undergoing long-term dialysis have been estimated at 0.3 per 100 patient-years (4,5) or ranging from ,1% to 7% of women (3). Recently, the relationship between dialysis intensity and outcomes has become clearer (6)(7)(8)(9)(10)(11)(12)(13)(14)(15), with increased dialysis delivery becoming standard practice and nocturnal hemodialysis potentially providing superior fertility and outcomes (16)(17)(18). Recent reports suggest that results of these pregnancies are superior to those reported prior to the 1990s, with fetal survival rates of up to 70%-90% (3)(4)(5)(6)(7)9,10,16,(19)(20)(21).…”

Pregnancy in Womаn on Dial Ysis

“…После начала заместительной почечной тера-пии додиализный уровень мочевины остался в пределах нормы. От неосложненной беременности на 39-й неде-ле родился здоровый ребенок массой 3000 г. Таким об-разом, допустима и такая схема диализа [20].…”

Grossesse en insuffisance rénale terminale : épidémiologie, prise en charge et pronostic

“…La duré e hebdomadaire de dialyse amé liore significativement le pronostic des grossesses avec un terme plus avancé et des poids de naissance plus é levé s pour des duré es de dialyse plus longues [20,21]. On retrouve dans la litté rature plusieurs descriptions de dialyse longue, entre 36 et 42 heures par semaine, ayant permis des naissances à terme avec des poids proche de 3000 g [43,44]. Les meilleurs ré sultats ont é té obtenus lors de dialyses nocturnes longues quotidiennes (48 heures par semaine).…”