BACKGROUND Young women wishing to become living kidney donors frequently ask whether nephrectomy will affect their future pregnancies. METHODS We conducted a retrospective cohort study of living kidney donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy nondonors from the general population (788 pregnancies after cohort entry). Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with follow-up through linked health care databases until March 2013. Donors and nondonors were matched with respect to age, year of cohort entry, residency (urban or rural), income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry. The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia. Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes. RESULTS Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; odds ratio for donors, 2.4; 95% confidence interval, 1.2 to 5.0; P = 0.01). Each component of the primary outcome was also more common among donors (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia). There were no significant differences between donors and nondonors with respect to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively). There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation. CONCLUSIONS Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health. (Funded by the Canadian Institutes of Health Research and others.)

Results: After conversion to INHD, median values for phosphorus decreased from 5.9 to 3.7 mg/dl (P < 0.01), alkaline phosphatase level increased from 84 to 161 U/L (P < 0.01), and percentage reduction in urea increased from 74 to 89% (P < 0.01). The mean number of antihypertensive drugs prescribed declined from 2.0 to 1.5 (P < 0.05) during the course of INHD, and the mean daily dosage of phosphate binders declined from 6.2 to 4.9 at study end (P < 0.05). There was a significant reduction in erythropoietin-stimulating agent use of 1992 U/wk (P < 0.01). There was no significant change in median hemoglobin, iron saturation, corrected calcium, or parathyroid hormone levels. Overall, quality of life, sleep, intradialytic cramps, appetite, and energy level all improved significantly on INHD.Conclusions: INHD offers an effective form of HD for long-term dialysis patients who are unable to perform home HD.

Currently, the majority of living kidney donors are women, and these young-women donors are often concerned about the possible effect of kidney donation on future pregnancies. Animal studies have shown evidence of higher blood pressure and urinary protein excretion in animals with 1 kidney compared with animals with 2. However, human studies that have compared donors with healthy nondonors during pregnancy have yielded conflicting results.In this retrospective, matched-cohort study, the authors compared kidney donors to matched, healthy nondonors with regard to risk of developing gestational hypertension or preeclampsia, as well as other maternal and fetal outcomes. They used databases in Ontario to compare pregnancy outcomes in 85 eligible women who donated a kidney between 1992 and 2010 with 510 healthy, nondonors. Baseline characteristics compared were age at the time of cohort entry, urban or rural location, income, the number of pregnancies at 20 weeks' gestation at cohort entry, and time to first pregnancy after cohort entry. The primary outcome was obtained from diagnostic codes for gestational hypertension or preeclampsia; secondary outcomes examined more specifically other maternal and fetal outcomes.Over an approximately 11-year period, 595 women were followed up through their pregnancies. Donors and nondonors had the same number of doctor visits during pregnancy, but gestational hypertension or preeclampsia was higher among donors (11% vs 5%; odds ratio for donors, 2.4; 95% confidence interval, 1.2-5.0; P = 0.01). Secondary outcomes revealed no significant difference in the rate of preterm birth (8% vs 7%) and low birth weight (6% vs 4%). There were no reports of miscarriage, stillbirth, or maternal death in either group.The risks of gestational hypertension or preeclampsia are higher in kidney donors than in nondonors with similar baseline health.

Background and objectives Patients with ESKD are sedentary. When patient-identified barriers to exercise are addressed, recruitment and retention in exercise trials remain low, suggesting that the trial design may not resonate with them. Therefore, we conducted a survey of patients on dialysis to assess perceived benefits and barriers to exercise and discover preferred outcomes and exercise type by dialysis modality and age in anticipation of designing future randomized, controlled trials.Design, setting, participants, & measurements English-and French-speaking patients with ESKD treated with hemodialysis or peritoneal dialysis were recruited from two tertiary care hospitals in Ottawa and Montreal, Canada. Summary descriptive statistics were used to describe patient responses; then, they were separated by dialysis modality and age category. ResultsThe survey was completed by 423 participants. Current activity levels were similar across modalities (P=0.35); 78% of younger patients walked at least 10 minutes at a time on 3 or more days compared with only 58% of older patients (P=0.001). The two most desired benefits of exercise were improved energy (18%) and strength (14%). The third priority differed, such that improved sleep, maintenance of independence, and longevity were selected by patients on peritoneal dialysis, patients on in-center hemodialysis, and patients on home hemodialysis, respectively. Older patients were most interested in improvements in energy, strength, and maintenance of independence, whereas younger patients were interested in improving energy, longevity, and transplant candidacy. Only 25% of patients were able to exercise without difficulty; the major barriers for the remaining patients were feeling patients were feeling too tired (55%), short of breath (50%), and too weak (49%). If patients were to exercise, they wanted to exercise at home (73%) using a combination of aerobic and resistance training (41%), regardless of modality or age category. ConclusionsThe majority of patients undergoing maintenance dialysis in two tertiary hospitals in Ottawa and Montreal report similar desired outcomes and barriers, with greater differences by age category than modality.