Fertility and reproductive care in chronic kidney disease

Dumanski, Sandra M.; Ahmed, Sofia B.

doi:10.1007/s40620-018-00569-9

Cited by 34 publications

(21 citation statements)

References 80 publications

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“…CKD is known to be associated with decreased fertility and poor reproductive outcomes, mostly attributed to the hypothalamic pituitary axis dysregulation. 25 Whereas we observed 100% spontaneous conception rate in our study population, with all of them conceiving within the first year of marriage.…”

Section: Discussionmentioning

confidence: 47%

Chronic kidney disease in pregnancy and fetomaternal outcome

Gupta

Chawla

Ara

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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Background: Chronic kidney disease is a heterogeneous group of renal dysfunctions with complex and varied presentations in pregnancy. With a long asymptomatic course, timely diagnosis and management is crucial for fetomaternal wellbeing.Methods: A retrospective cohort study over a period of 3 years and 4 months included all obstetric in patients with known or newly diagnosed renal disorders. Maternal outcome was measured with regard to biochemical parameters presence /absence of proteinuria, hypertension, mode of pregnancy termination and complications. Fetal outcome was noted with respect to antenatal complications, weight, Apgar, NICU stay. Computation of results was done using percentages, mean and proportions.Results: Out of 13 women studied, 53.8% were pre-diagnosed cases of renal dysfunction and 46.2% were diagnosed during pregnancy. 38% had proteinuria at first visit and 50% remained so even after delivery. 60% had history of pregnancy induced hypertension in their previous pregnancies. Secondary hypertension and superimposed preeclampsia were seen in 30% and 38% cases respectively, with only one patient requiring magnesium sulphate prophylaxis in post-partum. Cardiac dysfunction was found to be coexisting in 15.3% cases with pre-existing renal leision. Intrauterine growth restriction was seen in 61.5% cases Average fetal weight was 2. 26kg with 30% having NICU stay. 30.6% had preterm delivery. Mode of delivery was caesarean section in 46% cases.Conclusions: Pregnancy with CKD is a high-risk pregnancy with adverse fetomaternal outcomes. For optimal pregnancy outcomes, an expert multidisciplinary team is required. With limited studies in south Asian population, there needs to be an upgradation in registry system.

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Section: Discussionmentioning

confidence: 47%

Chronic kidney disease in pregnancy and fetomaternal outcome

Gupta

Chawla

Ara

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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“…Many men in chronic kidney disease, especially those in hemodialysis, exhibit subfertility or infertility due to several factors including hypogonadism, erectile dysfunction, and direct impairment of spermatogenesis with spermatotoxicity, genetic aberrations, infection, inflammation, or reactive oxygen species causing oligospermia or azoospermia. 3 Male reproductive system disorders result in altered composition of the seminal plasma which is a promising biological fluid for biomarker discovery. 12 In this sense, we analyzed the possible association of seminal AGP with changes in seminal parameters, considering the immunomodulatory functions 9 credited to the seminal AGP and few studies of regulatory mechanism related to seminal quality involving the seminal AGP.…”

Section: Discussionmentioning

confidence: 99%

“…It is well established that men with end-stage renal disease, especially in hemodialysis, have significantly lower fertility than members of the general population. 2,3 In one small study of hemodialysis patients, more than 40% had oligospermia or azoospermia. 4 The chronic kidney disease promotes significant changes in the reproductive tract in both males and females resulting in sub/infertility by the direct or indirect effect of uremia and other factors such as systemic inflammation and oxidative stress, genetic, hormonal, and immunological effects on the gonads.…”

Section: Introductionmentioning

confidence: 99%

α1-Acid glycoprotein and seminal parameter in chronic hemodialysis patients

et al. 2020

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Introduction: To find out the changes in seminal quality of hemodialysis chronic renal patients, we investigated the possible relationship between seminal parameter and seminal α1-acid glycoprotein levels in chronic hemodialysis patients. Methods: Prospective study of prevalence realized in the Hemodialysis Sector of the University Hospital of the University of Brasília, between July 2016 and December 2016. Men aged 18–60 years grouped into case groups (n = 81) represented by chronic hemodialysis patients and control group (n = 20) of healthy men without clinical or laboratory signs of infection and eugonadic. We performed a spermogram, hormonal profile, and assessment of leukocytes and seminal α1-acid glycoprotein level in the semen. The most appropriate statistical test was applied to verify differences and correlations between the studied variables. Results: The age in case and control is similar (49.47 ± 5.55 years vs 50.53 ± 4.24 years; p = 0.060). Mean level of α1-acid glycoprotein in human seminal plasma were not significantly different between case and control (48.52 ± 4.90 mg/L vs 46.33 ± 4.29 mg/L; p = 0.10) and between normosperm and oligosperm (47.76 ± 5.15 mg/L vs 49.48 ± 4.49 mg/L; p = 0.19). Mean level of α1-acid glycoprotein in human seminal plasma in the case group, which were classified into severe, moderate, mild, and normosperm, were similar to each other (p = 0.27) and did not correlate (p > 0.05) with the analyzed seminal parameters. All participants presented normal hormonal profile. Conclusion: Results of this study suggest that the seminal α1-acid glycoprotein levels do not help in the initial evaluation of patients with seminal parameter changes.

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“…Pregnancy in advanced CKD and on dialysis is still rather an uncommon event [3,4,5,6,7,8,9,10]. It also represents an important clinical challenge for the patients and their families, in particular when the kidney disease is first diagnosed in pregnancy and is advanced enough to need dialysis in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Fertility is inversely correlated with CKD stages [1,2,3,4]. The rates of fertility for those on dialysis have been estimated to be as low as 1:100 with respect to the overall population according to Australian and Italian data.…”

Section: Introductionmentioning

confidence: 99%

Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country

Hernández-Rivera

López

Bermúdez

et al. 2019

JCM

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Background: Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in Mexico City, with particular attention on the interference of social and cultural elements as well as resource limitations. Material and methods: CKD women who needed dialysis in pregnancy over the period 2002–2014 and had with complete demographic and outcome data were included in this retrospective study. Clinical background, renal function during pregnancy, dialysis schedule, and clinical outcomes were reviewed. Results: Forty pregnancies in women with CKD who needed dialysis in pregnancy (39 singleton and one twin pregnancy) were studied: All patients were treated with hemodialysis. Thirty-nine patients had CKD stages 4 or 5 at referral; only one patient was of stage 3b. Dialysis was considered as indicated in the presence of fluid overload, unresponsive hypertension in the setting of advanced CKD, or when blood urea nitrogen values were increased to around 50 mg/dL. However, the initiation of dialysis was often delayed by days or weeks. The main reason for delaying the initiation of dialysis was patient (and family) refusal to start treatment. All patients were treated with thrice weekly dialysis, in 3–5 hour sessions, with a target urea of <100 mg/dL. The number of hours on dialysis did not impact pregnancy outcomes. Ten pregnancies ended in miscarriages (8 spontaneous), 29 in pre-term delivery, and 1 in term delivery. Fifteen women were diagnosed with preeclampsia, one with eclampsia, and one with HELLP (hemolysis, elevated liver enzymes, low platelets,) syndrome. Twenty-four of the neonates survived (77.4% of live births); six singletons and one twin died as a consequence of prematurity. Two neonates displayed malformations: cleft palate with ear anomalies and duodenal atresia. Conclusions: CKD requiring hemodialysis in pregnancy is associated with a high frequency of complications; in the setting of delayed start and of thrice-weekly hemodialysis, dialysis schedules do not appear to influence outcomes.

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Fertility and reproductive care in chronic kidney disease

Cited by 34 publications

References 80 publications

Chronic kidney disease in pregnancy and fetomaternal outcome

Chronic kidney disease in pregnancy and fetomaternal outcome

α1-Acid glycoprotein and seminal parameter in chronic hemodialysis patients

Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country

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