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Kabinga SK, Otieno J, Ngige J, Mcligeyo SO. Chronic kidney disease, pregnancy and haemodialysis: Case reports from a single centre in Kenya and literature review. Obstet Med 2022; 15:136-140. [DOI: 10.1177/1753495x20985408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) and end stage kidney disease are prevalent even in women of reproductive age. These are known to reduce fertility and successful pregnancy. There are chances of conception even in advanced CKD, though laden with complications. We present two cases of women who conceived in advanced CKD and were on haemodialysis in a tertiary hospital in Kenya, and review of literature.
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Affiliation(s)
- Samuel K Kabinga
- East African Kidney Institute, University of Nairobi, Nairobi, Kenya
| | - Jackline Otieno
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - John Ngige
- Renal Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Seth O Mcligeyo
- East African Kidney Institute, University of Nairobi, Nairobi, Kenya
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2
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Shah S, Christianson AL, Thakar CV, Kramer S, Meganathan K, Leonard AC. Contraceptive Use Among Women With End-Stage Kidney Disease on Dialysis in the United States. Kidney Med 2020; 2:707-715.e1. [PMID: 33319196 PMCID: PMC7729239 DOI: 10.1016/j.xkme.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Rationale & Objective Although end-stage kidney disease (ESKD) adversely affects fertility, pregnancies can occur among women receiving dialysis. ESKD increases the risk for adverse pregnancy outcomes and little is known about contraceptive use in women undergoing dialysis. Study Design Retrospective cohort study. Setting & Participants Using the US Renal Data System covering January 1, 2005, through December 31, 2014, we evaluated for each calendar year women who for the entire year were aged 15 to 44 years, receiving dialysis, and with Medicare as the primary payer. Predictors Age, race/ethnicity, and calendar year of prevalent ESKD. Outcome Contraceptive use. Analytic Approach We determined rates of contraceptive use and used multivariable logistic regression to identify factors associated with contraceptive use. Results The study cohort included 35,732 women and represented 115,713 person-years. The rate of contraceptive use was 5.30% of person-years (95% CI, 5.17%-5.42%). Overall, contraceptive use increased from 2005 to 2014 (4.21%; 95% CI, 3.84%-4.59% vs 6.54%, 95% CI, 6.10%-6.99%). Compared with women aged 25 to 29 years, contraceptive use was higher in women aged 15 to 24 years (OR, 1.30; 95% CI, 1.18-1.43) and lower in women aged 30 to 34 years (OR, 0.74; 95% CI, 0.68-0.81), 35 to 39 years (OR, 0.46; 95% CI, 0.42-0.50), and 40 to 44 years (OR, 0.30; 95% CI, 0.27-0.34). Compared with White women, contraceptive use was higher in Black (OR, 1.12; 95% CI, 1.02-1.24) and Native American women (OR, 1.60; 95% CI, 1.25-2.05). Women with ESKD due to glomerulonephritis had a higher likelihood of contraceptive use than women with ESKD due to diabetes (OR, 1.22; 95% CI, 1.06-1.42). Women receiving peritoneal dialysis had a lower likelihood of contraceptive use than women receiving hemodialysis (OR, 0.85; 95% CI, 0.78-0.93). Compared with women without predialysis nephrology care, contraceptive use was higher in women who received predialysis nephrology care for 12 or fewer months (OR, 1.22; 95% CI, 1.09-1.37) and more than 12 months (OR, 1.33; 95% CI, 1.20-1.47). Limitations Retrospective design and use of administrative data. Conclusions Among women with ESKD undergoing dialysis, contraceptive use remains low at 5.30%. Younger age, Native American and Black race/ethnicity, ESKD due to glomerulonephritis, hemodialysis, and predialysis nephrology care are associated with a higher likelihood of contraceptive use. The study highlights the importance of prepregnancy counseling for contraceptive use in women receiving dialysis.
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Affiliation(s)
- Silvi Shah
- Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, OH
| | | | - Charuhas V Thakar
- Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, OH.,Cincinnati Veteran Affairs Medical Center, Cincinnati, OH
| | - Samantha Kramer
- Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, OH
| | | | - Anthony C Leonard
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH
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Arai H, Mori KP, Yokoi H, Mizuta K, Ogura J, Suginami K, Endo T, Ikeda Y, Matsubara T, Tsukamoto T, Yanagita M. Intensified hemodialysis for complicated pregnancy in a primigravida with advanced maternal age: a case report with literature review focusing on appropriate hemodialysis management during pregnancy. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00296-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pregnancy in dialysis patients is rare but challenging both for nephrologists and obstetricians. Although intensified hemodialysis is effective to achieve favorable clinical outcomes in this clinical setting, the evidence concerning reliable parameters for the optimal dialysis prescription is scarce. Herein, we report a case of a primigravida with advanced maternal age who underwent a normal spontaneous vaginal delivery at full term managed by intensified hemodialysis, and discuss reliable indicators of the appropriate dialysis prescription.
Case presentation
A 39-year-old primigravida with end-stage renal disease was referred to our department for hemodialysis management during pregnancy. She had a history of multiple gynecologic disorders, including cervical dysplasia, right tubal ectopic pregnancy and spontaneous abortion; consequently, she conceived through in vitro fertilization and embryo transfer. After pregnancy was confirmed, an intensified hemodialysis schedule with weekly duration of 36 hours was employed to prevent volume overload and the accumulation of hyperosmotic substances. Utilizing maternal blood pressure, plasma atrial natriuretic peptide levels and fetal development as indicators of volume status, we incremented her dry weight by 300–400 g per week in the first and second trimester and 100–200 g per week in the third trimester, respectively. Serum urea nitrogen levels were persistently maintained below 50 mg/dL. Throughout pregnancy, fetal growth and development were within normal limits. At 38 weeks and 3 days of gestation, she delivered a healthy child vaginally without complications. To date, the child’s development has been normal, both physically and mentally.
Conclusions
Pregnancy in dialysis patients with advanced age that leads to a normal childbirth is exceptionally rare. Our case is the hemodialysis patient with the most advanced age who achieves a normal spontaneous vaginal delivery at full term. Considering that cardiovascular system and endogenous metabolism dynamically alter during pregnancy, various clinical parameters should be closely monitored to modify dialysis settings accordingly. Of note, our case suggests that plasma atrial natriuretic peptide level is a useful parameter for the appropriate dry weight. Intensified hemodialysis is an effective and reliable measure that can achieve normal pregnancy in dialysis patients, even in a primigravida with advanced maternal age.
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Hewawasam E, Gulyani A, Davies CE, Sullivan E, Wark S, Clayton PA, McDonald SP, Jesudason S. Parenthood and pregnancy in Australians receiving treatment for end-stage kidney disease: protocol of a national study of perinatal and parental outcomes through population record linkage. BMJ Open 2020; 10:e036329. [PMID: 32457079 PMCID: PMC7252957 DOI: 10.1136/bmjopen-2019-036329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Achieving parenthood is challenging in individuals receiving renal replacement therapy (RRT; dialysis or kidney transplantation) for end-stage kidney disease. Decision-making regarding parenthood in RRT recipients should be underpinned by robust data, yet there is limited data on parental factors that drive adverse health outcomes. Therefore, we aim to investigate the perinatal risks and outcomes in parents receiving RRT. METHODS AND ANALYSIS This is a multijurisdictional probabilistic data linkage study of perinatal, hospital, birth, death and renal registers from 1991 to 2013 from New South Wales, Western Australia, South Australia and the Australian Capital Territory. This study includes all babies born ≥20 weeks' gestation or 400 g birth weight captured through mandated data collection in the perinatal data sets. Through linkage with the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, babies exposed to RRT (and their parents) will be compared with babies who have not been exposed to RRT (and their parents) to determine obstetric and fetal outcomes, birth rates and fertility rates. One of the novel aspects of this study is the method that will be used to link fathers receiving RRT to the mothers and their babies within the perinatal data sets, using the birth register, enabling the identification of family units. The linked data set will be used to validate the parenthood events directly reported to ANZDATA. ETHICS AND DISSEMINATION Ethics approval was obtained from Human Research Ethics Committees (HREC) and Aboriginal HREC in each jurisdiction. Findings of this study will be disseminated at scientific conferences and in peer-reviewed journals in tabular and aggregated forms. De-identified data will be presented and individual patients will not be identified. We will aim to present findings to relevant stakeholders (eg, patients, clinicians and policymakers) to maximise translational impact of research findings.
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Affiliation(s)
- Erandi Hewawasam
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aarti Gulyani
- School of Pharmacy and Medical Science, University of South Australia, Adelaide, South Australia, Australia
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth Sullivan
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sally Wark
- Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Shah S, Christianson AL, Meganathan K, Leonard AC, Schauer DP, Thakar CV. Racial Differences and Factors Associated with Pregnancy in ESKD Patients on Dialysis in the United States. J Am Soc Nephrol 2019; 30:2437-2448. [PMID: 31554657 DOI: 10.1681/asn.2019030234] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/23/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pregnancy in women with ESKD undergoing dialysis is uncommon due to impaired fertility. Data on pregnancy in women on dialysis in the United States is scarce. METHODS We evaluated a retrospective cohort of 47,555 women aged 15-44 years on dialysis between January 1, 2005 and December 31, 2013 using data from the United States Renal Data System with Medicare as primary payer. We calculated pregnancy rates and identified factors associated with pregnancy. RESULTS In 47,555 women on dialysis, 2352 pregnancies were identified. Pregnancy rate was 17.8 per thousand person years (PTPY) with the highest rate in women aged 20-24 (40.9 PTPY). In the adjusted time-to-event analysis, a higher likelihood of pregnancy was seen in Native American (HR, 1.77; 95% CI, 1.33 to 2.36), Hispanic (HR, 1.51; 95% CI, 1.32 to 1.73), and black (HR, 1.33; 95% CI, 1.18 to 1.49) women than in white women. A higher rate of pregnancy was seen in women with ESKD due to malignancy (HR, 1.64; 95% CI, 1.27 to 2.12), GN (HR, 1.38; 95% CI, 1.21 to 1.58), hypertension (HR, 1.32; 95% CI, 1.16 to 1.51), and secondary GN/vasculitis (HR, 1.18; 95% CI, 1.02 to 1.37) than ESKD due to diabetes. A lower likelihood of pregnancy was seen among women on peritoneal dialysis than on hemodialysis (HR, 0.47; 95% CI, 0.41 to 0.55). CONCLUSIONS The pregnancy rate is higher in women on dialysis than previous reports indicate. A higher likelihood of pregnancy was associated with race/ethnicity, ESKD cause, and dialysis modality.
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Affiliation(s)
- Silvi Shah
- Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, Ohio;
| | | | | | | | - Daniel P Schauer
- Internal Medicine, University of Cincinnati, Cincinnati, Ohio; and
| | - Charuhas V Thakar
- Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, Ohio.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio
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Abstract
Conventional hemodialysis is associated with high morbidity and mortality rates, as well as a reduced quality of life. There is a growing interest in the provision of more intensive hemodialysis, due to associated benefits in terms of reduced cardiovascular morbidity, better regulation of mineral metabolism, as well as its impact on quality of life measures, fertility, and sleep. Nocturnal hemodialysis, both in center and at home, allows the delivery of more intensive hemodialysis. This review discusses the benefits of nocturnal hemodialysis and evaluates the evidence based on available literature.
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Shaw J, Katopodis C, Hladunewich MA, Ryz K. Changing Dialysis Modality during Pregnancy: A Case Report. Perit Dial Int 2019; 38:456-458. [PMID: 30413638 DOI: 10.3747/pdi.2018.00054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pregnancy in patients with end-stage renal disease is rare, with a paucity of management guidelines in the literature. Various hemodialysis (HD) and peritoneal dialysis (PD) protocols have been used to successfully manage pregnancy in this population; however, there is a growing body of evidence that the best maternal and fetal outcomes are associated with intensified, high-dose HD. The optimal timing of transition from PD to HD is not known for prevalent PD patients who become pregnant. We report the case of a 32-year-old aboriginal female who became pregnant while being treated with chronic PD. She was converted to intensive HD early in the second trimester and underwent a planned caesarian section at 36 weeks with excellent outcomes for mother and child.
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Affiliation(s)
- James Shaw
- Section of Nephrology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christina Katopodis
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michelle A Hladunewich
- Division of Nephrology and Obstetric Medicine, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Krista Ryz
- Section of Nephrology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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8
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Systemic Lupus Erythematosus and Pregnancy: A Brief Review. J Obstet Gynaecol India 2019; 69:104-109. [PMID: 30956462 DOI: 10.1007/s13224-019-01212-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/21/2019] [Indexed: 01/21/2023] Open
Abstract
Systemic lupus erythematosus is a chronic multisystemic autoimmune disease that predominantly affects young women of childbearing age group. There is a complex immunologic interplay during pregnancy in patients with systemic lupus erythematosus. The pregnancy has direct impact on the disease where an increased rate of flares is noted, and lupus leads to increased risk of hypertensive diseases of pregnancy, preterm birth as well as miscarriages, particularly those with antiphospholipid antibodies. Neonates born to patients with lupus are at increased risk of neonatal lupus as well as heart block if born to patients with positive SSA/SSB. Despite the increased risk of morbidity, recent data suggest improved outcomes in pregnant patients with lupus. A multidisciplinary approach with careful monitoring of pregnancy and lupus could reduce adverse outcomes in these patients. This requires careful pregnancy planning, defining the clinical and serologic involvement of lupus, careful monitoring the patient for adverse pregnancy outcome as well as lupus flares and comprehensive understanding of the drugs that can be safely used in pregnancy. Fetuses should be carefully monitored for heart and neonates for neonatal lupus. Hydroxychloroquine, azathioprine and corticosteroids can be used during pregnancy and may reduce the risk of adverse outcomes. Similarly, appropriate therapy needs to be instituted for hypertensive diseases in pregnancy. Anticoagulant therapy may be necessary for patients with antiphospholipid syndrome.
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Piccoli GB, Zakharova E, Attini R, Ibarra Hernandez M, Orozco Guillien A, Alrukhaimi M, Liu ZH, Ashuntantang G, Covella B, Cabiddu G, Li PKT, Garcia-Garcia G, Levin A. Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases. J Clin Med 2018; 7:E415. [PMID: 30400594 PMCID: PMC6262338 DOI: 10.3390/jcm7110415] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/28/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023] Open
Abstract
Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy.
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia.
- Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia.
- Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia.
| | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy.
| | - Margarita Ibarra Hernandez
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico.
| | | | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE.
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China. zhihong--
| | - Gloria Ashuntantang
- Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon.
| | - Bianca Covella
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | | | - Philip Kam Tao Li
- Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico.
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Ross LE, Swift PA, Newbold SM, Bramham K, Hurley A, Gallagher H. An Alternative Approach to Delivering Intensive Dialysis in Pregnancy. Perit Dial Int 2017; 36:575-7. [PMID: 27659934 DOI: 10.3747/pdi.2016.00051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pregnancy outcomes in patients with end-stage renal disease (ESRD) on dialysis are improving. Recent literature supports intensive hemodialysis (HD) as the modality of choice during pregnancy in ESRD. We report the successful delivery of a healthy infant at full term in a patient with ESRD by supplementing peritoneal dialysis (PD) with intermittent HD to achieve adequate dialysis intensity.
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Affiliation(s)
- Louise E Ross
- South West Thames Renal and Transplantation Unit, St Helier Hospital, Carshalton, Surrey, UK
| | - Pauline A Swift
- South West Thames Renal and Transplantation Unit, St Helier Hospital, Carshalton, Surrey, UK
| | - Sandra M Newbold
- Obstetrics and Gynaecology, St Peter's Hospital, Chertsey, Surrey, UK
| | | | - Anne Hurley
- South West Thames Renal and Transplantation Unit, St Helier Hospital, Carshalton, Surrey, UK
| | - Hugh Gallagher
- South West Thames Renal and Transplantation Unit, St Helier Hospital, Carshalton, Surrey, UK
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Bramham K. Dialysis and pregnancy: no longer the impossible. Nephrol Dial Transplant 2016; 31:1763-1765. [PMID: 27229465 DOI: 10.1093/ndt/gfw216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/21/2016] [Indexed: 01/26/2023] Open
Affiliation(s)
- Kate Bramham
- Department of Renal Medicine, Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK
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12
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Abstract
Pregnancy in women with end stage renal disease on renal replacement therapy is uncommon due to the physiologic changes associated with renal failure as well as the complexities and risk involved in managing these patients. As most of these women had long periods of illness with chronic kidney disease, the effects of their chronic illness together with the current societal trends to delay child bearing to a more advanced maternal age can hamper fertility. For those able to conceive, intensified hemodialysis (HD), through longer and/or more frequent dialysis sessions, offers improved maternal and neonatal outcomes. Intensified HD is most conveniently offered in the patient's home, where possible. This review expands the scope of the Implementing Hemodialysis in the Home website and associated supplement published previously in Hemodialysis International and includes information tailored to women of reproductive age. We describe the necessary counseling that women should receive before conception and before intensification of HD, and provide a detailed management strategy that includes nephrologic and obstetric care, should pregnancy occur.
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Affiliation(s)
- Michelle Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dori Schatell
- Executive Director, Medical Education Institute, Inc., Madison, Wisconsin, USA
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13
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Successful Pregnancy Using the NxStage Home Hemodialysis System. Case Rep Nephrol 2016; 2016:1358625. [PMID: 26949554 PMCID: PMC4754476 DOI: 10.1155/2016/1358625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 11/18/2022] Open
Abstract
Pregnancy in the setting of the uremic milieu of renal disease has a lower success rate than in the normal population and is a rare event. While intensified renal replacement therapy (RRT) during pregnancy can lead to improved outcomes, most studies have focused on nocturnal hemodialysis as the main RRT in pregnancy. Although thousands of patients use the home NxStage System One short daily hemodialysis (SDHD) machine in the United States, pregnancy outcomes with this therapy are unknown. The NxStage System One uses low-volume dialysate and hence small and middle molecule clearance may differ compared to conventional therapies and affect pregnancy outcomes. We report a case of a successful conception and pregnancy using the home NxStage system. The NxStage system may provide an alternative to the more routinely used NHD or standard SDHD therapies for women of childbearing age.
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Akbari A, Hladunewich M, Burns K, Moretti F, Arkoub RA, Brown P, Hiremath S. Circulating angiogenic factors in a pregnant woman on intensive hemodialysis: a case report. Can J Kidney Health Dis 2016; 3:7. [PMID: 26909159 PMCID: PMC4763449 DOI: 10.1186/s40697-016-0096-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy in patients on chronic hemodialysis therapy, though unlikely, does happen rarely. Intensive hemodialysis is thought to offer a better survival advantage to the unborn child. Circulating angiogenic factors are helpful for prognostication of pregnant patients with chronic kidney disease who are not on dialysis. Data on their utilization in dialysis patients, however, are limited. CASE PRESENTATION We report the case of a patient with a history of interstitial nephritis who had a kidney transplant that failed after 8 years due to membranous nephropathy. She was initiated on hemodialysis three sessions per week and conceived after being on dialysis for 6 weeks. She was switched to intensive hemodialysis at 8 weeks of gestation and had a C-section because of hypertension at 35 weeks, with delivery of a healthy girl weighing 2012 g. Serum angiogenic factors (placental growth factor and soluble fms-like tyrosine kinase) were measured at 32, 33, and 34 weeks of gestation and at 1, 2, and 3 weeks postpartum. Serum angiogenic factors were similar to what has been reported for patients with chronic kidney disease and were not consistent with preeclampsia. CONCLUSIONS Our case report expands on the literature regarding intensive hemodialysis and angiogenic factor utilization in pregnant dialysis patients. Our case report suggests that starting intensive dialysis early in pregnancy is safe and concentration of angiogenic factors are similar to those reported for patients without kidney disease, except for PIGF levels, which are somewhat higher.
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Affiliation(s)
- Ayub Akbari
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ; The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa, ON K1H 7W9 Canada
| | - Michelle Hladunewich
- Department of Medicine, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario Canada
| | - Kevin Burns
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Felipe Moretti
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario Canada
| | - Rima Abou Arkoub
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Pierre Brown
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
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Piccoli GB, Postorino V, Cabiddu G, Ghiotto S, Guzzo G, Roggero S, Manca E, Puddu R, Meloni F, Attini R, Moi P, Guida B, Maxia S, Piga A, Mazzone L, Pani A, Postorino M. Children of a lesser god or miracles? An emotional and behavioural profile of children born to mothers on dialysis in Italy: a multicentre nationwide study 2000–12. Nephrol Dial Transplant 2015; 30:1193-1202. [DOI: 10.1093/ndt/gfv127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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16
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Cabiddu G, Castellino S, Gernone G, Santoro D, Giacchino F, Credendino O, Daidone G, Gregorini G, Moroni G, Attini R, Minelli F, Manisco G, Todros T, Piccoli GB. Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy. J Nephrol 2015; 28:279-88. [PMID: 25966799 DOI: 10.1007/s40620-015-0191-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/06/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion. METHODS A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000-2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips. MAIN RESULTS Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75% may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.
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Panaye M, Jolivot A, Lemoine S, Guebre-Egziabher F, Doret M, Morelon E, Juillard L. [Pregnancies in hemodialysis and in patients with end-stage chronic kidney disease : epidemiology, management and prognosis]. Nephrol Ther 2014; 10:485-91. [PMID: 25457994 DOI: 10.1016/j.nephro.2014.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/07/2014] [Accepted: 06/25/2014] [Indexed: 10/24/2022]
Abstract
Pregnancy in patients presenting end-stage renal disease is rare and there are currently no recommendations for the management of these patients. In hemodialysis patients, reduced fertility and medical reluctance limit the frequency of pregnancies. Although the prognosis has significantly improved, a significant risk for unfavorable maternal (pre-eclampsia, eclampsia) and fetal (pre-term birth, intrauterine growth restriction, still death) outcome still remains. Increasing dialysis dose with the initiation of daily dialysis sessions, early adaptation of medications to limit teratogenicity and management of chronic kidney disease complications (anemia, hypertension) are required. A tight coordination between nephrologists and obstetricians remains the central pillar of the care. In peritoneal dialysis, pregnancy is also possible with modification of the exchange protocol and reducing volumes.
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Affiliation(s)
- Marine Panaye
- Service de néphrologie, hôpital Édouard-Herriot, pavillon P, 5, place d'Arsonval, 69003 Lyon, France.
| | - Anne Jolivot
- Service de néphrologie, hôpital Édouard-Herriot, pavillon P, 5, place d'Arsonval, 69003 Lyon, France
| | - Sandrine Lemoine
- Service de néphrologie, hôpital Édouard-Herriot, pavillon P, 5, place d'Arsonval, 69003 Lyon, France; Université Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France
| | - Fitsum Guebre-Egziabher
- Service de néphrologie, hôpital Édouard-Herriot, pavillon P, 5, place d'Arsonval, 69003 Lyon, France
| | - Muriel Doret
- Université Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France; Service gynécologie obstétrique, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Emmanuel Morelon
- Université Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France; Service transplantation et immunologie clinique, hôpital Édouard-Herriot, pavillon P, 5, place d'Arsonval, 69003 Lyon, France
| | - Laurent Juillard
- Service de néphrologie, hôpital Édouard-Herriot, pavillon P, 5, place d'Arsonval, 69003 Lyon, France; Université Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France
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Piccoli GB, Cabiddu G, Daidone G, Guzzo G, Maxia S, Ciniglio I, Postorino V, Loi V, Ghiotto S, Nichelatti M, Attini R, Coscia A, Postorino M, Pani A, Castellino S, Gernone G, Calabria S, Galliani M, di Tullio M, Fersini S, Grazia Chiappini M, Proietti E, Saffiotti S, Brunati C, Montoli A, Esposito C, Montagna G, Salvatore T, Amatruda O, Casiraghi E, Pieruzzi F, Di Benedetto A, Alfisi G, Monique B, Leveque A, Giofre F, Alati G, Lombardi L. The children of dialysis: live-born babies from on-dialysis mothers in Italy--an epidemiological perspective comparing dialysis, kidney transplantation and the overall population. Nephrol Dial Transplant 2014; 29:1578-1586. [DOI: 10.1093/ndt/gfu092] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Sulaiman K, Vuppali M, Abreo K. Patient Outcome in Pregnancy Requiring Dialysis: A Case Series. ACTA ACUST UNITED AC 2014. [DOI: 10.2174/1874303x01407010052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The optimal management of pregnant dialysis patients remains a great challenge for nephrologists, end-stage renal disease being a predictor of adverse outcomes in this condition. We report a single-center experience of four patients requiring dialysis during pregnancy, all of which resulted in successful delivery of viable infants. Our success rate may reflect an overall improvement in management of this population, with special attention paid to multiple risk factors. These include blood pressure and volume control, anemia management with erythropoietin analogues, nutritional intake and total dose of dialysis.
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20
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Capitaine L, Van Assche K, Pennings G, Sterckx S. Pediatric priority in kidney allocation: challenging its acceptability. Transpl Int 2014; 27:533-40. [DOI: 10.1111/tri.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 09/13/2013] [Accepted: 01/24/2014] [Indexed: 01/08/2023]
Affiliation(s)
| | - Kristof Van Assche
- Research Group on Law, Science, Technology and Society; Vrije Universiteit Brussel; Brussels Belgium
| | - Guido Pennings
- Bioethics Institute Ghent; Ghent University; Ghent Belgium
| | - Sigrid Sterckx
- Bioethics Institute Ghent; Ghent University; Ghent Belgium
- Research Group on Law, Science, Technology and Society; Vrije Universiteit Brussel; Brussels Belgium
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21
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Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M, Tennankore K, Keunen J, Hui D, Chan CT. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol 2014; 25:1103-9. [PMID: 24525032 DOI: 10.1681/asn.2013080825] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pregnancy is rare in women with ESRD and when it occurs, it is often accompanied by significant maternal and fetal morbidity and even mortality. Preliminary data from the Toronto Nocturnal Hemodialysis Program suggested that increased clearance of uremic toxins by intensified hemodialysis improves pregnancy outcomes, but small numbers and the absence of a comparator group limited widespread applicability of these findings. We compared pregnancy outcomes from 22 pregnancies in the Toronto Pregnancy and Kidney Disease Clinic and Registry (2000-2013) with outcomes from 70 pregnancies in the American Registry for Pregnancy in Dialysis Patients (1990-2011). The primary outcome was the live birth rate and secondary outcomes included gestational age and birth weight. The live birth rate in the Canadian cohort (86.4%) was significantly higher than the rate in the American cohort (61.4%; P=0.03). Among patients with established ESRD, the median duration of pregnancy in the more intensively dialyzed Toronto cohort was 36 weeks (interquartile range, 32-37) compared with 27 weeks (interquartile range, 21-35) in the American cohort (P=0.002). Furthermore, a dose response between dialysis intensity and pregnancy outcomes emerged, with live birth rates of 48% in women dialyzed ≤20 hours per week and 85% in women dialyzed >36 hours per week (P=0.02), with a longer gestational age and greater infant birth weight for women dialyzed more intensively. Pregnancy complications were few and manageable. We conclude that pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis.
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Affiliation(s)
- Michelle A Hladunewich
- Department of Medicine, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada;
| | - Susan Hou
- Department of Medicine, Division of Nephrology, Loyola University Medical Center, Maywood Illinois
| | - Ayodele Odutayo
- Department of Medicine, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tom Cornelis
- Department of Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andreas Pierratos
- Department of Medicine, Division of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada
| | - Marc Goldstein
- Department of Medicine, Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Karthik Tennankore
- Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Johannes Keunen
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada; and
| | - Dini Hui
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christopher T Chan
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Jesudason S, Grace BS, McDonald SP. Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD. Clin J Am Soc Nephrol 2013; 9:143-9. [PMID: 24235285 DOI: 10.2215/cjn.03560413] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Pregnancy in ESRD is rare and poses substantial risk for mother and baby. This study describes a large series of pregnancies in women undergoing long-term dialysis treatment and reviews maternal and fetal outcomes. Specifically, women who had conceived before and after starting long-term dialysis are compared. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENT All pregnancies reported to the Australian and New Zealand Dialysis and Transplantation Registry from 2001 to 2011 (n=77), following the introduction of specific parenthood data collection, were analyzed. RESULTS Between 2001 and 2011, there were 77 pregnancies among 73 women. Of these, 53 pregnancies were in women who conceived after long-term dialysis was established and 24 pregnancies occurred before dialysis began. The overall live birth rate (after exclusion of elective terminations) was 73%. In pregnancies reaching 20 weeks gestation, the live birth rate was 82%. Women who conceived before dialysis commenced had significantly higher live birth rates (91% versus 63%; P=0.03), but infants had similar birthweight and gestational age. This difference in live birth rate was primarily due to higher rates of early pregnancy loss before 20 weeks in women who conceived after dialysis was established. In pregnancies that reached 20 weeks or more, the live birth rate was higher in women with conception before dialysis commenced (91% versus 76%; P=0.28). Overall, the median gestational age was 33.8 weeks (interquartile range, 30.6-37.6 weeks) and median birthweight was 1750 g (interquartile range, 1130-2417 g). More than 40% of pregnancies reached >34 weeks' gestation; prematurity at <28 weeks was 11.4% and 28-day neonatal survival rate was 98%. CONCLUSIONS Women with kidney disease who start long-term dialysis after conception have superior live birth rates compared with those already established on dialysis at the time of conception, although these pregnancies remain high risk.
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Affiliation(s)
- Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service and, †Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia, ‡Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Shiraki N, Nakashima A, Doi S, Carrero JJ, Sugiya N, Ueno T, Stenvinkel P, Kohno N, Masaki T. Low serum testosterone is associated with atherosclerosis in postmenopausal women undergoing hemodialysis. Clin Exp Nephrol 2013; 18:499-506. [DOI: 10.1007/s10157-013-0840-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 07/03/2013] [Indexed: 12/17/2022]
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Chinnappa V, Ankichetty S, Angle P, Halpern SH. Chronic kidney disease in pregnancy. Int J Obstet Anesth 2013; 22:223-30. [PMID: 23707038 DOI: 10.1016/j.ijoa.2013.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/23/2013] [Indexed: 10/26/2022]
Abstract
Parturients with renal insufficiency or failure present a significant challenge for the anesthesiologist. Impaired renal function compromises fertility and increases both maternal and fetal morbidity and mortality. Close communication amongst medical specialists, including nephrologists, obstetricians, neonatologists and anesthesiologists is required to ensure the safety of mother and child. Pre-existing diseases should be optimized and close surveillance of maternal and fetal condition is required. Kidney function may deteriorate during pregnancy, necessitating early intervention. The goal is to maintain hemodynamic and physiologic stability while the demands of the pregnancy change. Drugs that may adversely affect the fetus, are nephrotoxic or are dependent on renal elimination should be avoided.
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Affiliation(s)
- V Chinnappa
- Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada
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Nadeau-Fredette AC, Hladunewich M, Hui D, Keunen J, Chan CT. End-stage renal disease and pregnancy. Adv Chronic Kidney Dis 2013; 20:246-52. [PMID: 23928389 DOI: 10.1053/j.ackd.2013.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 01/16/2023]
Abstract
Pregnancy in patients with ESRD is rare and remains especially challenging. Because endocrine abnormalities and sexual dysfunction decrease fertility, conception rates have been remarkably low in this patient population. Moreover, when pregnancy does occur, hypertension, preeclampsia, anemia, intrauterine growth restriction, preterm delivery, stillbirth, and other complications can decrease the rate of a successful outcome. However, recent experiences with intensive hemodialysis managed by a multidisciplinary team are encouraging with respect to better overall outcomes for mothers and infants. In this article, we discuss the main causes of decreased fertility in dialysis-dependent women, review outcomes and complications of pregnancy among dialysis patients with a special focus on recent intensive hemodialysis data, and summarize the current best strategy to manage pregnant women on dialysis.
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26
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Tennankore KK, Chan CT, Curran SP. Intensive home haemodialysis: benefits and barriers. Nat Rev Nephrol 2012; 8:515-22. [DOI: 10.1038/nrneph.2012.145] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kukla A, Issa N, Ibrahim HN. Pregnancy in renal transplantation: Recipient and donor aspects in the Arab world. Arab J Urol 2012; 10:175-81. [PMID: 26558022 PMCID: PMC4442883 DOI: 10.1016/j.aju.2012.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/17/2012] [Accepted: 02/18/2012] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE There are many kidney transplant recipients and living donors of reproductive age, and the prevalence of pregnancies in kidney transplant recipients can reach 55% in the Middle Eastern countries. Living kidney donation is predominant in this region. As the risks and outcomes of pregnancy should be a part of counselling for both recipients and donors, we reviewed available reports on maternal and foetal outcomes in these particular populations. METHODS Information was obtained from retrospective analyses of a large database, and from single-centre reports indexed in PubMed on pregnancy in donors and kidney transplant recipients. The keywords used for the search included 'fertility', 'kidney disease', 'pregnancy', 'maternal/foetal outcomes', 'kidney transplant recipient', 'immunosuppression side-effects', 'living donor' and 'Arab countries'. RESULTS Pregnancies in kidney transplant recipients are most successful in those with adequate kidney function and controlled comorbidities. Similarly to other regions, pregnant recipients in the Middle East had a higher risk of pre-eclampsia (26%) and gestational diabetes (7%) than in the general population. Caesarean section was quite common, with an incidence rate of 61%, and the incidence of pre-term birth reached 46%. CONCLUSIONS Most living donors can have successful pregnancies and should not be routinely discouraged. Women who had pregnancies before and after donation were more likely to have adverse maternal outcomes (gestational diabetes, hypertension, proteinuria, and pre-eclampsia) in the latter, but no adverse foetal outcomes were found after donation. The evaluation before donation should include a gestational history and counselling about the potential risks.
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Affiliation(s)
- Aleksandra Kukla
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Naim Issa
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Hassan N Ibrahim
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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