High volume on line hemodiafiltration in dialysis pregnant patients: predilutional or postdilutional?

Puddu, Marcelo; Migueliz, María Lucía; Rosa-Díez, Guillermo; Crucelegui, Soledad; Martinez, Agustina Heredia; Luxardo, Rosario; Amalfi, H; Egolf, Alicia; Fernández, María Isabel González; Núñez, N Álvarez; Canaud, Bernard

doi:10.1007/s10047-020-01226-4

Cited by 4 publications

(6 citation statements)

References 13 publications

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“…Intensification of dialysis treatment is part of best clinical practice, improving pregnancy outcomes. HD frequency is intended to increase the treatment time and frequency of dialysis sessions, maintaining low levels of uremic toxin and ensuring hemodynamic stability, avoiding effective hypovolemia, intradialytic hypotension and large osmotic and electrolyte fluctuations [7].…”

Section: Resultsmentioning

confidence: 99%

Increased Hemodialysis Sessions during Pregnancy Improve Fetal Development and Reduce Mortality: Literature Review

Feu¹,

Dias²,

Martinuzo³

2022

J Clin Nephrol Ren Care

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Section: Resultsmentioning

confidence: 99%

Increased Hemodialysis Sessions during Pregnancy Improve Fetal Development and Reduce Mortality: Literature Review

Feu¹,

Dias²,

Martinuzo³

2022

J Clin Nephrol Ren Care

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“…In 2020, Puddu and colleagues described 2 pregnant women on high-volume HDF whose pregnancies went to term and who gave birth to healthy infants [8] . In the same year, Crucelegui et al [9] described a 32-year-old hemodialysis-dependent woman on pre-dilutional HDF who had a successful pregnancy and delivered a healthy new-born baby.…”

Section: Discussionmentioning

confidence: 99%

“…Four case reports have described favorable outcomes in pregnant patients on hemodiafiltration (HDF) [6–9]. In all but 1 patient, who presented with metrorrhagia and a small placental hematoma, there were no complications from the use of bicarbonate dialysate acidified with citrate in pre-dilutional HDF [8]. We report the first case of a pregnant hemodialysis-dependent patient on daily high-volume online post-dilution HDF with citrate-acidified dialysate.…”

Section: Introductionmentioning

confidence: 99%

“…Dialysis dose appears to be the cornerstone of these improved results. Four case reports have described favorable outcomes in pregnant patients on hemodiafiltration (HDF) [6][7][8][9]. In all but 1 patient, who presented with metrorrhagia and a small placental hematoma, there were no complications from the use of bicarbonate dialysate acidified with citrate in predilutional HDF [8].…”

Section: Introductionmentioning

confidence: 99%

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Success of Pregnancy in a Patient on High-Volume Hemodiafiltration with Citrate-Acidified Dialysate

Pellé

Eddine

Rieu³

et al. 2023

Case Rep Nephrol Dial

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Although pregnancy in dialysis patients is rare, recent reports in the literature have shown improvement in pregnancy outcome in this population. Increasing doses of dialysis have led to improvement in fetal prognosis, but recommendations are still lacking, and there are few documented reports of pregnant woman on high-volume online hemodiafiltration. Here, we report the first successful pregnancy in a 28-year-old patient on daily high-volume online post-dilution hemodiafiltration with a citrate dialysate. At 37 weeks and 1 day, she delivered a healthy 2.3 kg baby that did not require neonatal intensive care. This case report suggests that hemodiafiltration with a dialysate acidified with citrate is safe in pregnancy. Further reports and a registry are necessary to confirm that high-volume online hemodiafiltration with a citrate dialysate should be the preferred dialysis modality in pregnant women.

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“…Her vascular access was with a left brachio-cephalic fistula, and HDF sessions used a blood flow (Qb) of 250 mL/min with ultrapure dialysate at 500 mL/min flow rate. As pregnancy is pro-thrombotic and her blood flow rate was lower than previous published reports on HDF in pregnancy, we have chosen pre-dilution HDF to achieve a higher convective volume and to reduce extracorporeal circuit clotting [ 5 ]. In addition, we chose pre-dilution HDF as studies comparing high volume HDF in pre-dilution and post-dilution mode, using comparable convection volume exchange rates, have shown that pre-dilution mode has reduced sieving coefficients for sodium, calcium and magnesium, and thus losses of calcium and magnesium would be expected to be less with pre-dilution compared to post-dilution mode [ 6 ].…”

Section: Case Presentationmentioning

confidence: 99%

Segmental bioimpedance in pregnant end stage renal failure patient for dry weight titration and volume management (case report)

Haroon,

Tan,

Lau

et al. 2023

BMC Nephrol

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Background Volume assessment, dry weight titration, and blood pressure control in pregnant kidney failure patients are often challenging, with physiological fluid accumulation in the trunk and lower limbs and an increased risk of preeclampsia. We used segmental bioimpedance in the volume management of our kidney failure patient on haemodialysis. Case presentation We report a case of a female patient on maintenance haemodiafiltration with no residual kidney function for whom we used segmental bioimpedance to guide dry weight adjustment. At different gestational periods, we targeted a different extracellular to total body water ratio according to body segments. This allowed us to support her high-risk pregnancy, identify her as probably developing preeclampsia and trigger a plan for closer monitoring and delivery during the third trimester when she had rapid weight gain. Conclusion Segmental bioimpedance is a practical, simple, and non-invasive test that can be performed at the dialysis unit and is useful as an adjunct decision-making tool in the management of pregnant dialysis patients.

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High volume on line hemodiafiltration in dialysis pregnant patients: predilutional or postdilutional?

Cited by 4 publications

References 13 publications

Increased Hemodialysis Sessions during Pregnancy Improve Fetal Development and Reduce Mortality: Literature Review

Increased Hemodialysis Sessions during Pregnancy Improve Fetal Development and Reduce Mortality: Literature Review

Success of Pregnancy in a Patient on High-Volume Hemodiafiltration with Citrate-Acidified Dialysate

Segmental bioimpedance in pregnant end stage renal failure patient for dry weight titration and volume management (case report)

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