Requiring Higher Doses of Erythropoietin Suggests Pregnancy in Hemodialysis Patients

Abstract

Background/Aims: Pregnancy in hemodialysis (HD) patients tends to be diagnosed late because of its infrequency and the lack of validity of urine pregnancy tests, and because these patients tend to have menstrual irregularities. The outcome is influenced by pregnancy-related anemia. We investigated the characteristics of pregnancy-related anemia and whether it is a useful diagnostic clue to pregnancy in HD patients. Methods: We retrospectively investigated six pregnancies of 5 HD patients (mean age 30 years), including 4 patients treated with recombinant human erythropoietin (rHuEpo) and a transfusion-dependent patient with two pregnancies in the pre-rHuEpo era. Results: The mean duration of HD was 6 years, the mean duration of the patients’ marriages at the time of pregnancy was 6 years, and the mean gestational age at diagnosis was 11 weeks and 4 days. The progression of anemia (an 8% decrease in the hematocrit) was detected by 8 weeks of gestation in all patients. The prepregnancy hematocrit was stable in 5 pregnancies, facilitating the detection of changes, but during one of the pregnancies of the transfusion-dependent patient the hematocrit was low and was influenced by the transfusions. The amount of rHuEpo required to attain a target hematocrit of 30% increased gradually or rapidly until delivery. Conclusions: The progression of anemia or hyporesponsiveness to rHuEpo was a useful early diagnostic clue to pregnancy in HD patients. However, the prepregnancy hematocrit should be stabilized with rHuEpo, so that decreases can be easily detected. The precise mechanisms of hyporesponsiveness to rHuEpo, which progressed during pregnancy and subsided after delivery, remain to be clarified.

Pregnancy on Intensified Hemodialysis: Fetal Surveillance and Perinatal Outcome

“…In two larger surveys, longer duration of dialysis time during pregnancy resulted in a reduced prematurity rate and an increased number of viable pregnancies [1,2] . By lowering the urea level and water load, the incidence of polyhydramnios and dialysis-induced hypotension may be reduced [13,14] , thereby improving fetal outcome. All 5 pregnancies evaluated here resulted in live neonates; we therefore present one of the world's largest cases series for pregnant women on maintenance dialysis, with clearly the best fetal and maternal outcomes.…”

Continuous Erythropoietin Delivery by Muscle-Targeted Gene Transfer Usingin VivoElectroporation

“…Indeed, the response to rHuEpo is variable in each patient (Eschbach, 1996) and is influenced by numerous factors (Maruyama et al, 1998). Therefore, it is important in Epo gene therapy that the expression levels be easily changed according to the outcome of the initial trial for a patient.…”

Pregnancy in end-stage renal disease patients on hemodialysis: two case reports

“…An increase dose of dialysis with a weekly Kt/V of 6-8 or dialysis 5-6 days/week is considered beneficial [10]. We were also dialyzing both patients 6 days a week.…”