End-Stage Kidney Disease and Dialysis in Pregnancy

Oliverio, Andrea L.; Hladunewich, Michelle A.

doi:10.1053/j.ackd.2020.06.001

Cited by 34 publications

(38 citation statements)

References 67 publications

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“…Treatment and medical care have changed in the area of obstetric nephrology over the last 20 years [ 10 , 37 ]. Intensive hemodialysis is now the standard model of care for women receiving dialysis in pregnancy, particularly if residual renal function is minimal [ 41 – 43 ]. Thus, in women with ESKD, intensification of hemodialysis, targeting a serum blood urea nitrogen <35 mg/dL or 36 hours of dialysis per week in women with no residual kidney function, is associated with improved live birth rates and longer gestational age [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Intensive hemodialysis is now the standard model of care for women receiving dialysis in pregnancy, particularly if residual renal function is minimal [ 41 – 43 ]. Thus, in women with ESKD, intensification of hemodialysis, targeting a serum blood urea nitrogen <35 mg/dL or 36 hours of dialysis per week in women with no residual kidney function, is associated with improved live birth rates and longer gestational age [ 43 ]. Hladunewich [ 42 ], and Oliverio & Hladunewich [ 43 ] concluded that pregnancy may be safe and feasible in women with ESKD receiving intensive hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, in women with ESKD, intensification of hemodialysis, targeting a serum blood urea nitrogen <35 mg/dL or 36 hours of dialysis per week in women with no residual kidney function, is associated with improved live birth rates and longer gestational age [ 43 ]. Hladunewich [ 42 ], and Oliverio & Hladunewich [ 43 ] concluded that pregnancy may be safe and feasible in women with ESKD receiving intensive hemodialysis. Moreover, fertility is significantly increased after kidney transplantation, and the chances of successful delivery are increased compared to women on dialysis [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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The experience of being a mother with end stage renal disease: A qualitative study of women receiving treatment at an ambulatory dialysis unit

et al. 2021

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Background End-stage kidney disease (ESKD) has considerable effects on the quality of life, impairing daily activities and leading to lifestyle changes. The purpose of this study was therefore to explore the experience of motherhood and taking care of children in women with ESKD. Methods A qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited using non-probabilistic purposeful sampling. In total, 14 women with ESKD were included, who were treated at the dialysis unit of a Spanish hospital. In-depth interviews (unstructured and semi-structured interviews) and researchers’ field notes were used to collect the data. A systematic text condensation analysis was performed. The techniques performed and application procedures used to control trustworthiness were credibility, transferability, dependability, and confirmability. Results Three themes emerged from the data. “Coping with being a mother” described how women are faced with the decision to become mothers and assess the risks of pregnancy. The second theme, called “Children and the experience of illness”, highlighted the women’s struggle to prevent the disease from affecting their children emotionally or disrupting their lives. The third theme, “Fear of genetic transmission”, was based on the women’s fear of passing the disease on to their children. Conclusions Deciding to become a mother and taking care of children represents a challenge for women with ESKD, coupled with the losses in their lives caused by the disease. These findings are only relevant to women on dialysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The experience of being a mother with end stage renal disease: A qualitative study of women receiving treatment at an ambulatory dialysis unit

et al. 2021

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“…Finally, while some variability in physician views might be explained by uncertainty and limited guidelines, physicians also may judge the justifiability of risks to women and future children associated with pregnancy in women with CKD, including women who have received a kidney transplant. For women with advanced CKD or on dialysis, these risks include pregnancy loss, preterm delivery and low birth weight, preeclampsia, and accelerated decline in residual renal function (Oliverio & Hladunewich 2020;Wiles & Oliveira, 2019). Women who have been pregnant also are more likely to become sensitized, making it more difficult to find a compatible kidney for transplantation later (Alkhunaizi et al, 2015).…”

Section: Ckd and Reproductive Counsellingmentioning

confidence: 99%

Ignorance is Not Bliss: The Case for Comprehensive Reproductive Counseling for Women with Chronic Kidney Disease

2021

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The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, including information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population. KeywordsChronic kidney disease • Dialysis • End stage renal disease • Kidney transplantation • Pregnancy • Reproduction • Reproductive counseling • Shared decision making Women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant, receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with

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“…1 Diabetic nephropathy, observed in 30%-40% of patients with diabetes, is the main cause of end-stage kidney disease. 2,3 The diagnosis of early stage in diabetic nephropathy is very important for the prevention of chronic renal injury. Early diabetic nephropathy is characterized by microalbuminuria, which is associated with glomerular hyperfiltration and renal hypertrophy.…”

Section: Introductionmentioning

confidence: 99%

Exercise training ameliorates early diabetic kidney injury by regulating the H₂S/SIRT1/p53 pathway

Yang

Cao

et al. 2021

The FASEB Journal

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Exercise training exerts protective effects against diabetic nephropathy. This study aimed to investigate whether exercise training could attenuate diabetic renal injury via regulating endogenous hydrogen sulfide (H2S) production. First, C57BL/6 mice were allocated into the control, diabetes, exercise, and diabetes + exercise groups. Diabetes was induced by intraperitoneal injection of streptozotocin (STZ). Treadmill exercise continued for four weeks. Second, mice was allocated into the control, diabetes, H2S and diabetes + H2S groups. H2S donor sodium hydrosulfide (NaHS) was intraperitoneally injected once daily for four weeks. STZ‐induced diabetic mice exhibited glomerular hypertrophy, tissue fibrosis and increased urine albumin levels, urine protein‐ and albumin‐to‐creatinine ratios, which were relieved by exercise training. Diabetic renal injury was associated with apoptotic cell death, as evidenced by the enhanced caspase‐3 activity, the increased TdT‐mediated dUTP nick‐end labeling ‐positive cells and the reduced expression of anti‐apoptotic proteins, all of which were attenuated by exercise training. Exercise training enhanced renal sirtuin 1 (SIRT1) expression in diabetic mice, accompanied by an inhibition of the p53‐#ediated pro‐apoptotic pathway. Furthermore, exercise training restored the STZ‐mediated downregulation of cystathionine‐β‐synthase (CBS) and cystathionine‐γ‐lyase (CSE) and the reduced renal H2S production. NaHS treatment restored SIRT1 expression, inhibited the p53‐mediated pro‐apoptotic pathway and attenuated diabetes‐associated apoptosis and renal injury. In high glucose‐treated MPC5 podocytes, NaHS treatment inhibited the p53‐mediated pro‐apoptotic pathway and podocyte apoptosis in a SIRT1‐dependent manner. Collectively, exercise training upregulated CBS/CSE expression and enhanced the endogenous H2S production in renal tissues, thereby contributing to the modulation of the SIRT1/p53 apoptosis pathway and improvement of diabetic nephropathy.

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End-Stage Kidney Disease and Dialysis in Pregnancy

Cited by 34 publications

References 67 publications

The experience of being a mother with end stage renal disease: A qualitative study of women receiving treatment at an ambulatory dialysis unit

The experience of being a mother with end stage renal disease: A qualitative study of women receiving treatment at an ambulatory dialysis unit

Ignorance is Not Bliss: The Case for Comprehensive Reproductive Counseling for Women with Chronic Kidney Disease

Exercise training ameliorates early diabetic kidney injury by regulating the H₂S/SIRT1/p53 pathway

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End-Stage Kidney Disease and Dialysis in Pregnancy

Cited by 34 publications

References 67 publications

The experience of being a mother with end stage renal disease: A qualitative study of women receiving treatment at an ambulatory dialysis unit

The experience of being a mother with end stage renal disease: A qualitative study of women receiving treatment at an ambulatory dialysis unit

Ignorance is Not Bliss: The Case for Comprehensive Reproductive Counseling for Women with Chronic Kidney Disease

Exercise training ameliorates early diabetic kidney injury by regulating the H2S/SIRT1/p53 pathway

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Exercise training ameliorates early diabetic kidney injury by regulating the H₂S/SIRT1/p53 pathway