Pregnancy Outcomes in French Hemodialysis Patients

Abstract

Background: Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal complications. Scarcity of available data from large cohorts impedes fair medical counseling. Methods: This is a descriptive, retrospective, multi-centric study. Pregnant women on HD during the period from 1985 to 2015 in France were included. The primary outcome was a living infant discharged from hospital, while secondary outcomes included gestational age and birth weight. Results: We identified 100 pregnancies in 84 women on HD, from 41 centers. Chronic HD was initiated during pregnancy for 17.7% (14/79) of patients explaining a 19.8% prevalence of catheter (19/96) and a preserved residual diuresis for 50% of pregnancy (43/86). Seventy-six (89.4%) women performed daily dialysis during the third trimester (6 times per week). Our primary outcome was met for 78% of newborns with a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1,719 ± 730 g. Conclusions: Our study is one of the largest series of ­pregnancies in HD patients. Despite recent progresses, these pregnancies remain at high risk, reinforcing the need for an early nephrologist-obstetrician skilled team co-management.

Successful full-term delivery in a patient with maintenance hemodialysis using natriuretic peptides as volume markers without X-ray examination: a case report and literature review

“…There are a few clinical studies regarding delivery in patients on hemodialysis. A retrospective, multicentric study consisting of 100 pregnancies in patients on hemodialysis from 1985 to 2015 in France revealed a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1719 ± 730 g [20]. Another retrospective cohort study consisting of 93 pregnancies in patients on hemodialysis from 2000 to 2017 in Brazil revealed a median gestational age of 35 (12-39) and a mean birth weight of 1698 ± 719 g; in addition, preeclampsia, primigravida, average midweek BUN, polyhydramnios, and residual diuresis were associated with birth weight [21].…”

Parenthood With Kidney Failure: Answering Questions Patients Ask About Pregnancy

“…77 Quantifying and communicating pregnancy risk to women is an essential component of counseling. 20 In Figure 1, 42,[48][49][50]65,68,[78][79][80][81][82][83][84][85] we provide a contemporaneous "snapshot" of key perinatal and obstetrical outcomes for dialyzed and transplanted women, based on selected recent, larger studies of cohorts in developed countries. In Figure 2, we provide a "traffic light system" co-designed by patients from our Pregnancy Advisory Group.…”

Briefly Noted

“…Mean weekly dialysis time in the third trimester was 20.5 ± 3.0 hours. 16 Patients with scleroderma on dialysis (N = 2385) had an increased risk of death (HR 1.4), a greater chance of renal recovery (HR 2.7), and a lesser chance of transplantation (HR 0.5) than did age, race, Fifty consecutive patients admitted to an ICU for acute kidney injury related to multiple myeloma who required dialysis were studied. Sixty days after initiating dialysis, 23 patients (46%) were alive without dialysis and 10 (20%) were still receiving it; 17 (32%) had died.…”

“…A retrospective review of 100 pregnancies (in 84 women) from 1985 to 2015 in France found a 78% fetal survival and high rates of preeclampsia (19%), hydramnios (42%), and low birth weight (45%). Mean weekly dialysis time in the third trimester was 20.5 ± 3.0 hours …”