Successful triplet pregnancy in a patient on chronic haemodialysis

Multiple Pregnancies in CKD Patients

“…Our study, conducted in the context of scarce information and a series of generally positive case reports, demonstrates a significant additional risk for adverse outcomes in multiple pregnancies in CKD patients (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). On a baseline of relatively high morbidity and mortality typical of multiple pregnancies, the availability of a large control group allowed comparison with low-risk twin pregnancies, performed by considering all twin pregnancies together or by limiting the analysis to the more common subset of dichorionic dizygotic twins (Table 2) (33,34).…”

“…To note, there were no significant differences in baseline characteristics in CKD patients and controls, except for the week of referral, occurring later in the unit dedicated to kidney diseases in pregnancy. The referral week was similar for patients with and without CKD in the outpatient unit dedicated to twins; as a rule, the patients with CKD were referred earlier to the twins unit (median week of referral, 13 weeks; range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] than to the CKD unit (median week of referral, 22 weeks; range, 6-33). CKD was discovered in pregnancy in 10 of 20 patients; the two units work together and the patients are referred to the CKD unit after having performed blood and urine tests and kidney ultrasounds, hence the delay between first suspicion of CKD, diagnosis, and referral ( Table 1).…”

“…This is the case with multiple pregnancies in CKD patients. Except for a few patients in the context of larger series, only sporadic, exceptional cases have been reported, many of which are in the context of kidney transplantation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Most of the available cases reported successful outcomes, presumably because of a baseline bias, probably a joint effect of the comprehensible unwillingness to report patients with a poor outcome, and of publication bias (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Obstetric outcomes in women with end-stage renal disease on chronic dialysis: a review

“…Data from the remaining 208 women representing 222 pregnancies and 225 conceptions, including a pair of twins 5 and a set of triplets, 6 were analysed. The mean age of the patients was 31.7 + 10.4 years.…”

“…2 Since then, however, support for these pregnancies has improved with advances in the management of patients with renal failure, such as the introduction of high-flux dialysis and the use of erythropoietin therapy for anaemia, and progress in care for premature neonates. This appears to have translated into more encouraging survival rates: Souqiyyeh et al 3 described a 30% live birth rate in Saudi Arabia 1992, Toma et al 2 reported 66.2% in Japan in 1999, Okundaye et al 4 found 40.2% in the United States in 1998, and there has also been a growing number of case reports detailing successful singleton and even multiple 5,6 pregnancies.…”