Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 13 , ISSUE 1 ( January-February, 2021 ) > List of Articles

Original Article

Chronic Kidney Disease with Pregnancy: Hemodialysis can be considered for Better Maternal and Fetal Outcomes

Sumesh Choudhary, Vineet V Mishra, Saiprasad Shinde, Himanshu Patel, Rohina Aggarwal, Khushali Gandhi

Keywords : Chronic kidney disease, Hemodialysis, Pregnancy

Citation Information : Choudhary S, Mishra VV, Shinde S, Patel H, Aggarwal R, Gandhi K. Chronic Kidney Disease with Pregnancy: Hemodialysis can be considered for Better Maternal and Fetal Outcomes. J South Asian Feder Obs Gynae 2021; 13 (1):11-14.

DOI: 10.5005/jp-journals-10006-1859

License: CC BY-NC 4.0

Published Online: 00-02-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: To analyze five patients with chronic kidney disease (CKD) with pregnancy managed with hemodialysis for better maternal and fetal outcomes. Design: Original article. Setting: A hospital-based prospective study. Patients: Five women with CKD reported in second trimester of pregnancy. Interventions: Hemodialysis done in all antenatal patients. Main outcome measures: Analyze maternal and fetal outcomes in patients with CKD treated with hemodialysis during pregnancy. Using hemodialysis to prolong the pregnancy by preventing preterm delivery. Results: Out of five patients, three patients had live fetuses and two patients’ fetuses had intrauterine growth retardation and low birth weight babies. Pregnancy was prolonged to 9 weeks in two patients, 4 weeks in two patients, and 21 days in the fifth patient. Conclusions: Possible return of fertility to the dialysis patient and pregnancy is most often unexpected. Hemodialysis to be considered for better maternal and fetal outcomes. Hemoglobin, electrolyte, nutrition, and proper weight gain to be monitored. Careful monitoring of the patient to avoid intradialytic hypotension is important. The close collaboration and motivation of the different medical and paramedical staff also depend on the outcome of the pregnancy. It is strongly advised to the dialyzed woman to wait for having been transplanted successfully to plan a pregnancy.


PDF Share
  1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1–S266.
  2. Fischer MJ, Lehnerz SD, Hebert JR, et al. Kidney disease is an independent risk factor for adverse fetal and maternal outcomes in pregnancy. Am J Kidney Dis 2004;43:415–423. DOI: 10.1053/j.ajkd.2003.10.041.
  3. Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis 1999;33:235. DOI: 10.1016/s0272-6386(99)70296-9.
  4. Hayslett JP. Interaction of renal disease and pregnancy. Kidney Int 1984;25:579. DOI: 10.1038/ki.1984.58.
  5. Hou S. Pregnancy in women with chronic renal disease. N Engl J Med 1985;312:836. DOI: 10.1056/NEJM198503283121306.
  6. Confortini P, Galanti G, Ancona G, et al. Full term pregnancy and successful delivery in a patient on chronic haemodialysis. Proc Eur Dial Transplant Assoc 1970;8:74–80.
  7. Fischer MJ. Chronic kidney disease and pregnancy: maternal and fetal outcomes. Adv Chronic Kidney Dis 2007;14:132–145. DOI: 10.1053/j.ackd.2007.01.004.
  8. Toma H, Tanabe K, Tokumoto T, et al. Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey. Nephrol Dial Transplant 1999;14(6):1511–1516. DOI: 10.1093/ndt/14.6.1511.
  9. Hou S. Modification of dialysis regimens for pregnancy. Int J Artif Organs 2002;25(9):823–826. DOI: 10.1177/039139880202500902.
  10. Asamiya Y, Otsubo S, Matsuda Y, et al. The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int 2009;75:1217. DOI: 10.1038/ki.2009.48.
  11. Giatras I, Delphine P, Malone D. Pregnancy during dialysis: case report and management guidelines. Nephrol Dial Transplant 1998;13:3266–3272. DOI: 10.1093/ndt/13.12.3266.
  12. Shemin D. Dialysis in pregnant women with chronic kidney disease. Sem Dial 2003;16(5):379–383. DOI: 10.1046/j.1525-139x.2003.16084_1.x.
  13. Sonfilippo F, Vaughn WK, Bollinger RR, et al. Comparative effects of pregnancy, transfusion, and prior graft rejection on sensitization and renal transplant results. Transplantation 1982;34(6):360–366. DOI: 10.1097/00007890-198212000-00010.
  14. Pekonen F, Rosenlof K, Rutanean EM, et al. Erythropoietin binding sites in human fetal tissues. Acta Endocrinol 1987;116:561–567. DOI: 10.1530/acta.0.1160561.
  15. Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. Am J Kidney Dis 1998;31(5):766–773. DOI: 10.1016/s0272-6386(98)70044-7.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.