Dialysis in Pregnant Women with Chronic Kidney Disease

Shemin, Douglas

doi:10.1046/j.1525-139x.2003.16084_1.x

Cited by 37 publications

(33 citation statements)

References 31 publications

(55 reference statements)

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“…Thus, the number of dialysis sessions should be increased (from 5 to 7 per week) and extended for a minimum of 20 hours per week, targeting plasmatic a urea level of 30-50 mg/dL 5,7,8 . Moreover, with more frequent sessions, less volume is withdrawn in each session, reducing the risk of maternal hypotension and its fetal impact 3,8 .…”

Section: Discussionmentioning

confidence: 99%

“…However, changes in CKD therapy and advances in dialysis techniques have allowed an increase in fertility in these women over the last decades [2][3][4] , with a calculated frequency from 0.3 to 1.5% per year 4 . The rate of live births in this group also increased to 40-50%.…”

Section: Introductionmentioning

confidence: 99%

“…Another risk of dialysis during pregnancy is the common occurrence of maternal hypotension throughout the procedure, which can cause poor placental perfusion and fetal distress 3 . Other fetal complications are: congenital anomalies (tetralogy of Fallot, genital changes), low birth weight (LBW), fetal growth restriction (FGR), polyhydramnios, prematurity (present in 84% of the cases) 9,10 , electrolyte disturbance (hypocalcemia) due to osmotic diuresis 5 , and neonatal deaths 9,10 .…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center

Suarez¹,

Costa²,

Parpinelli³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side. METHODS: Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high-risk prenatal care in Southeast Brazil. RESULTS: Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7. CONCLUSIONS: To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women. ResumoOBJETIVOS: Descrever os resultados maternos e neonatais de mulheres grávidas que estavam em tratamento de hemodiálise em um centro de referência no Sudeste brasileiro. MÉTODOS: Estudo retrospectivo e descritivo, com revisão de prontuários de todas as gestações em hemodiálise, acompanhadas no pré-natal especializado da região Sudeste do Brasil. RESULTADOS: Entre as 16 mulheres identificadas, 2 foram excluídas devido à perda de seguimento. Das 14 descritas, a hipertensão foi a causa mais frequente de insuficiência renal crônica (50% dos casos). A maioria (71,4%) realizava tratamento de hemodiálise há mais de um ano e todas elas foram submetidas a 5 ou 6 sessões por semana. Onze mulheres tinham hipertensão crônica, 1 das quais também era diabética, e 6 eram fumantes. Em relação às complicações da gravidez, 1 das mulheres hipertensas desenvolveu hipertensão maligna (com restrição de crescimento fetal e parto prematuro com 29 semanas), 2 tiveram edema pulmonar agudo e 2 apresentaram descolamento prematuro de placenta. O tipo de parto foi cesariana em 9 mulheres (64,3%). Todos os recém-nascidos tiveram Apgar aos cinco minutos maior que 7. CONCLUSÕES: Para melhorar os resultados perinatais e maternos de mulheres em hemodiálise, é importante ter uma abordagem multidisciplinar em centro de referência, um controle rigoroso da uremia, hemoglobina e pressão arterial materna, bem como acompanhar de perto o bem-estar fetal e a morbidade materna. Outra estratégia importante é a orientação adequada para contracepção nessas mulheres.Obste...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center

Suarez¹,

Costa²,

Parpinelli³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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“…Pregnant women on dialysis will generally require 16-24 hours of HD each week. Due to the potential for fetal malformations with formaldehyde or ethylene oxide exposure, biocompatible, non-reuse dialyzers are recommended (19).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy in dialysis patients: Two successful cases from a saudi renal center and management guidelines

Alsaran

Sabry

2009

ELECTRON J GEN MED

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“…3,4 The pregnancy rate of women of childbearing age having chronic dialysis is 1/40th that of women of similar age in the general population. 5 Infants born to women in the United States who conceive prior to the initiation of dialysis have a higher rate of survival than do those conceived while the mother undergoes HD (74% versus 40%). 1 Accumulating evidence indicates that treating azotemia with dialysis more than 20 hours/week with a Kt/ V > 5 correlates with the likelihood of delivering a live infant and of higher birth weight.…”

Section: Discussionmentioning

confidence: 99%