Successful Pregnancy in Patient on Regular Dialysis

Ackrill, P.; Goodwin, F. J.; Marsh, Frank; Stratton, Dan; Wagman, H.

doi:10.1097/00006254-197511000-00009

Cited by 4 publications

(11 citation statements)

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“…1 Although the clinical value of blood pressure control has not been demonstrated in all case reports, we observed that, overall, normalizing blood pressure was the common denominator in all successful pregnancies. 3 Our patient was always normotensive and we believe this was the main reason for the favorable outcome. In addition, special attention was given to avoid hypotensive episodes during dialysis.…”

Section: Discussionmentioning

confidence: 62%

“…Some authors recommend aggressive dialysis to achieve variable target predialysis blood urea nitrogen and creatinine values. 1,3,7 However, our patient received vigorous dialysis only after the 20th week of gestation, by which time organogenesis is completed. This suggests that azotemia may not be the most important factor influencing the outcome of pregnancy.…”

Section: Discussionmentioning

confidence: 92%

“…Review of the literature revealed that there have been few successful pregnancies in patients on long-term hemodialysis. [1][2][3][4] One published review on this subject 5 described patients who had conceived as much as 9 years after they had first started dialysis treatment, but successful pregnancy occurred only in those who had been treated for 4 years or less. An editorial 6 described a patient who had conceived twice after nine years of dialysis, but we could not find the date.…”

Section: Discussionmentioning

confidence: 99%

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Successful Pregnancy in a Patient on Long-Term Hemodialysis

et al. 1990

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Successful pregnancy is rare in patients who are on long-term dialysis. We describe normal delivery in a young woman who had been on dialysis treatment for more than four years. Case ReportA 38-year-old woman with a long history of proteinuria, microscopic hematuria, and hypertension had first been evaluated in September 1983 by the nephrology service immediately after her tenth delivery, which-was complicated by postpartum hemorrhage. At that time, she was found to have severe renal failure (serum creatinine, 620 μmol/L) with small kidneys. Renal biopsy was not done. Seven months later, she became progressively uremic and maintenance hemodialysis was commenced on a schedule of four hours three times per week using a 1.3 m 2 hollow-fiber dialyzer and glucose bicarbonate dialysate (sodium, 140; potassium, 2; HCO 3 35 mmol/L). She did well, her interdialytic weight gain averaged 1 to 2 kg, and her serum chemistry levels were acceptable. However, packed red cell transfusions were required every 3 to 4 months to control her anemia. Her residual renal function was 1 ml/min. Her blood pressure remained well controlled throughout this time. There was no clinical or radiological evidence of peripheral neuropathy, renal osteodystrophy, or cardiac dysfunction. Her medications included 1-α hydroxy vitamin D3 supplement (0.5 μg daily) and variable doses of aluminum hydroxide. She had had 10 fullterm normal deliveries, the last of which was in September 1983. Her menstrual periods continued to be regular even during dialysis.In October 1988, the patient felt fetal movements and a 20-week pregnancy was confirmed by ultrasound. Her dialysis regimen was increased to four hours, four times a week with no change in the setting, and more frequent packed red blood cell transfusions were required (Figure 1). Her heparin maintenance dose was doubled because of increased clotting of the dialyzers in the third trimester. Her 1-α hydroxy vitamin D3 dosage was increased to 1 μg daily. Her dialysis sessions during pregnancy were fairly stable and her blood pressure continued to be normal. At 32 weeks of pregnancy, shortly after a hemodialysis session, she experienced labor pains and a 1.9-kg male infant was delivered vaginally without complications. The placenta was macroscopically healthy and weighed 500 gm.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Successful Pregnancy in a Patient on Long-Term Hemodialysis

et al. 1990

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“…With the latter dialysis modality, the dialysis‐induced, large reduction in serum osmolality as a result of large decreases in the levels of waste products such as BUN, in the absence of comparable decreases in the “sequestered” amniotic fluid, may lead to movement of water into the amniotic cavity and the development of polyhydramnios in a pregnant dialysis patient. Better adjustment of plasma volume as a result of more frequent dialysis treatment may also help control hypertension, as well as lower the risk of dialysis‐induced hypotension, thus lowering the incidence of fetal distress and premature labor 9,11 , 12 . Serum electrolytes need to be monitored at least weekly to avoid hypokalemia.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with impaired renal function, however, this compensation cannot take place. The increased frequency of dialysis in pregnant patients has led Hou et al 9,11 . to advocate the use of a low‐bicarbonate dialysate (25 mEq/L) to avoid exposing the fetus to unphysiologic serum bicarbonate levels.…”

Section: Discussionmentioning

confidence: 99%

Phosphorus‐enriched hemodialysis during pregnancy: Two case reports

Hussain

Savin

Piering

et al. 2005

Hemodialysis International

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Successful pregnancy leading to delivery of a viable infant is an uncommon occurrence either in women with established renal disease or in those with renal failure requiring chronic dialytic treatment. The frequency of conception in patients with renal failure has increased, however, and the outcome of such pregnancies has improved over the past 32 years. Current guidelines for dialysis in pregnant women include prolonged dialysis times, generally 20 or more hours per week. This extensive dialysis regimen often results in a decrease in the serum inorganic phosphorus levels, with possible detrimental effects to the health of the mother and the unborn child. In this article, we report the successful multidisciplinary management of two pregnant women with end-stage renal disease, both of whom developed hypophosphatemia after initiation of intensive hemodialysis. Sodium phosphate salts were added to the dialysate of each patient and this addition successfully corrected the decrease in serum inorganic phosphate concentration. One patient was able to carry the pregnancy for 28 weeks with delivery of a healthy 1260-g infant. The pregnancy of the second patient ended at 25 weeks of gestation with delivery of a nonviable infant.

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Successful Pregnancies in Women Treated by Dialysis and Kidney Transplantation

1980

BJOG

224

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Summary The Registry of the European Dialysis and Transplant Association collected information on 120 successful pregnancies in women treated by dialysis and transplantation in 19 countries. Ninety‐seven women with transplants gave birth to 110 babies including five multiple pregnancies. The incidence of severe congenital malformation in these children was not substantially increased. There was evidence of damage to the transplant occurring either during or after pregnancy in 22 of the mothers. Sixteen successful pregnancies occurred in women on dialysis, all of whom had some residual renal function.

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Successful Pregnancy in Patient on Regular Dialysis

Abstract: made in groups with differing severities of illness or temperatures intergroup comparisons of the means of the logarithmic values were made by Student's unpaired t test. Case 4 was excluded from statistical analyses involving gastrin concentrations.

Cited by 4 publications

References 0 publications

Successful Pregnancy in a Patient on Long-Term Hemodialysis

Successful Pregnancy in a Patient on Long-Term Hemodialysis

Phosphorus‐enriched hemodialysis during pregnancy: Two case reports

Successful Pregnancies in Women Treated by Dialysis and Kidney Transplantation

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