The importance of increased dialysis and anemia management for infant survival in pregnant women on hemodialysis

Abstract

Despite advances in recent decades, infant survival in pregnant women on hemodialysis remains suboptimal. Asamiya et al. found that higher maternal hemoglobin was associated with successful pregnancy and maternal blood urea nitrogen (BUN) was negatively correlated with infant birth weight and gestational age. Their study suggests that increased or intensive dialysis to achieve predialysis maternal BUN levels <48 mg/dl along with increased doses of erythropoietin to ensure maternal hemoglobin levels > or =9.6+/-0.9 g/dl, should be the standard for pregnant women on hemodialysis.

Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD

“…Factors crucial to successful pregnancy outcome include increased dialysis delivery to optimize biochemical measures, particularly urea (6)(7)(8)(9)(10)(11)(12)16,18), control of hypertension, correction of anemia (7,15), close fetal monitoring (8,10), and a multidisciplinary approach to patient care (2,3,8). An important limitation of ANZDATA data are limited detail regarding such individual patient care, which would assist in further interpreting the differing outcomes observed in our cohort.…”

“…Conception rates in women undergoing long-term dialysis have been estimated at 0.3 per 100 patient-years (4,5) or ranging from ,1% to 7% of women (3). Recently, the relationship between dialysis intensity and outcomes has become clearer (6)(7)(8)(9)(10)(11)(12)(13)(14)(15), with increased dialysis delivery becoming standard practice and nocturnal hemodialysis potentially providing superior fertility and outcomes (16)(17)(18). Recent reports suggest that results of these pregnancies are superior to those reported prior to the 1990s, with fetal survival rates of up to 70%-90% (3)(4)(5)(6)(7)9,10,16,(19)(20)(21).…”

Disentangling the effects of climate, topography, soil and vegetation on stand-scale species richness in temperate forests

“…Uncontrolled anaemia is associated with adverse fetal outcomes (38). Intravenous iron and erythropoiesis stimulating agents (ESA) appear safe in pregnancy.…”

Pregnancy and Chronic Kidney Disease

“…22,41,44 Fetal survival in women undergoing dialysis was barely 50% a decade ago but slowly is improving worldwide and may lead to reconsidering aspects of the counseling policy for dialysis patients. 5,22,[45][46][47][48][49][50] However, because there still are serious maternal risks, including the occurrence of intraperitoneal hemorrhage and accelerated hypertension, 39-41,44-49 we do not recommend planning of a pregnancy in women with pre-existing severe renal dysfunction.…”