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Desbuissons G, Ngango L, Baudeau C, Fournier P. Successful twin pregnancy in a woman undergoing alternate diurnal and nocturnal hemodialysis. Hemodial Int 2024; 28:233-235. [PMID: 38356167 DOI: 10.1111/hdi.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/28/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
Although pregnancy has become more frequent in patients undergoing hemodialysis, it remains a relatively rare event and carries a high risk of complications for both the mother and the fetus. In parallel, multiple pregnancies are also associated with a high risk of complications for the mother and the fetus, even in healthy women. The presence of a twin pregnancy in a woman with chronic renal failure undergoing hemodialysis is an even rarer event and is considered a very high-risk situation. We describe the case of a 31-year-old hemodialysis patient who successfully gave birth to twins at 29 weeks after a period of alternate diurnal and nocturnal hemodialysis.
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Affiliation(s)
- Geoffroy Desbuissons
- Hôpital privé de l'Ouest Parisien, Service de Néphrologie, Trappes, France
- Hôpital Foch, Suresnes, France
| | - Liliane Ngango
- Hôpital privé de l'Ouest Parisien, Service de Néphrologie, Trappes, France
| | | | - Philippe Fournier
- Hôpital privé de l'Ouest Parisien, Service de Néphrologie, Trappes, France
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2
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Ankawi G, Tangirala N, Jesudason S, Hladunewich MA. Pregnancy in Patients Receiving Home Dialysis. Clin J Am Soc Nephrol 2024:01277230-990000000-00350. [PMID: 38285469 DOI: 10.2215/cjn.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/24/2024] [Indexed: 01/30/2024]
Abstract
Pregnancy is an important goal for many women with CKD or kidney failure, but important barriers exist, particularly as CKD stage progresses. Women with advanced CKD often have a limited fertility window and may miss their opportunity for a pregnancy if advised to defer until after kidney transplantation. Pregnancy rates in women with advanced kidney failure or receiving dialysis remain low, and despite the improved outcomes in recent years, these pregnancies remain high risk for both mother and baby with high rates of preterm birth due to both maternal and fetal complications. However, with increased experience and advances in models of care, this paradigm may be changing. Intensive hemodialysis regimens have been shown to improve both fertility and live birth rates. Increasing dialysis intensity and individualizing dialysis prescription to residual renal function, to achieve highly efficient clearances, has resulted in improved live birth rates, longer gestations, and higher birth weights. Intensive hemodialysis regimens, particularly nocturnal and home-based dialysis, are therefore a potential option for women with kidney failure desiring pregnancy. Global initiatives for the promotion and uptake of home-based dialysis are gaining momentum and may have advantages in this unique patient population. In this article, we review the epidemiology and outcomes of pregnancy in hemodialysis and peritoneal dialysis recipients. We discuss the role home-based therapies may play in helping women achieve more successful pregnancies and outline the principles and practicalities of management of dialysis in pregnancy with a focus on delivery of home modalities. The experience and perspectives of a patient are also shared.
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Affiliation(s)
- Ghada Ankawi
- Division of Nephrology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nishanta Tangirala
- Renal Department, Lyell McEwen Hospital, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital and School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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3
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Pellé G, Jalal Eddine A, Rieu P, Attias J, Fay S, Hertig A. Success of Pregnancy in a Patient on High-Volume Hemodiafiltration with Citrate-Acidified Dialysate. Case Rep Nephrol Dial 2023; 13:15-19. [PMID: 37013153 PMCID: PMC10066502 DOI: 10.1159/000528725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/29/2022] [Indexed: 04/03/2023] Open
Abstract
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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Affiliation(s)
- Gaëlle Pellé
- Department of Nephrology, Foch Hospital, Suresnes, France
| | | | | | | | - Stephanie Fay
- Department Gynecology, Foch Hospital, Suresnes, France
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4
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Baouche H, Jais JP, Meriem S, Kareche M, Moranne O, Vigneau C, Couchoud C. Pregnancy in women on chronic dialysis in the last decade (2010-2020): a systematic review. Clin Kidney J 2022; 16:138-150. [PMID: 36726433 PMCID: PMC9871848 DOI: 10.1093/ckj/sfac204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background Pregnant women with end-stage renal disease on chronic dialysis are at a high risk of maternal and foetal complications. Over the years, the prognosis of their pregnancies has improved with advances in dialysis treatments and maternal and neonatal care. We conducted this systematic review to examine the recent data on maternal and foetal outcomes in pregnant women with end-stage renal failure on chronic dialysis over the last decade. Methods We made a systematic review of studies on pregnant women on chronic dialysis published between 1 January 2010 and 31 December 2020. We searched the following electronic databases: Medline via PubMed, Embase and the Cochrane Library, with search strategies for each database. We checked the titles and abstracts identified by the search equation, and two independent reviewers assessed the articles retrieved. For each study, the two reviewers separately recorded the data from each selected article on a standardized data extraction form. For each article, we recorded relevant general information on the study, patient demographic characteristics, dialysis schedule, pregnancy complications and outcomes, maternal complications, and foetal and neonatal outcomes. Results The literature search yielded 1668 potentially relevant abstracts. After reviewing the titles, abstracts and full text, we identified 14 studies according to the inclusion criteria. All studies were observational, nine of them were retrospective and eight were from a single-centre experience. The total number of women included in these studies was 2364 (range 8-2008) and the total number of pregnancies was 2754 (range 8-2352). The patients' ages ranged from 15 to 45 years. Obesity was observed in 808 (34.2%) women and ranged from 1 to 778. Haemodialysis was the predominant modality with 2551 (92.6%) pregnancies, and 203 (7.4%) on peritoneal dialysis. Overall, 68 out of 402 (16.9%) spontaneous miscarriages, 21 out of 402 (5.2%) therapeutic abortions and 26 (8.3%) stillbirths among 313 (stillbirths and live births) were recorded. The mean or median gestational age at delivery ranged from 25.2 to 36 weeks. The main maternal complications were preeclampsia 11.9%, hypertension 7.7% and anaemia 3.9%. Live births represented 287 (71.4%) out of 402 pregnancies, birth weight ranged from 590 to 3500 g and preterm birth was the main, most common complication in all studies, ranging from 50% to 100%. Intrauterine growth restriction was present in 5.9% and small-for-gestational-age was reported in 18.9% of neonates. There were 22 (7.6%) neonatal deaths among 287 live births and 48 (15.3%) perinatal deaths among 313 total births (stillbirths and live births). Conclusions Presumably, considering the increase in the number of publications and the total number of pregnancies reported therein, the frequency of pregnancy in patients with end-stage chronic kidney disease treated by chronic dialysis has increased. However, the practice of treating pregnant women on dialysis differs significantly among countries. These findings highlight the need to standardize the definition of outcomes and healthcare for pregnant women on dialysis.
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Affiliation(s)
| | - Jean-Philippe Jais
- Department of Biostatistics, APHP–Necker–Enfants Malades Hospital, REIN Registry, University of Paris Cité, Paris, France
| | - Samy Meriem
- Department of Biostatistics, APHP–Necker–Enfants Malades Hospital, Paris, France
| | | | - Olivier Moranne
- Service Nephrologie–Dialyse–Apherese, Hopital Universitaire de Nimes, CHU Caremeau Nîmes, France,IDESP, UMR, Université de Montpellier, France
| | - Cécile Vigneau
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) –UMR S1085, Rennes, France
| | - Cécile Couchoud
- REIN Registry, Agence de la biomédecine, Saint Denis La Plaine, France
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5
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Jesudason S, Williamson A, Huuskes B, Hewawasam E. Parenthood with kidney failure: Answering questions patients ask about pregnancy. Kidney Int Rep 2022; 7:1477-1492. [PMID: 35812283 PMCID: PMC9263253 DOI: 10.1016/j.ekir.2022.04.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Achieving parenthood can be an important priority for women and men with kidney failure. In recent decades, the paradigm has shifted toward greater support of parenthood, with advances in our understanding of risks related to pregnancy and improvements in obstetrical and perinatal care. This review, codesigned by people with personal experience of kidney disease, provides guidance for nephrologists on how to answer the questions most asked by patients when planning for parenthood. We focus on important issues that arise in preconception counseling for women receiving dialysis and postkidney transplant. We summarize recent studies reflecting pregnancy outcomes in the modern era of nephrology, obstetrical, and perinatal care in developed countries. We present visual aids to help clinicians and women navigate pregnancy planning and risk assessment. Key principles of pregnancy management are outlined. Finally, we explore outcomes of fatherhood in males with kidney failure.
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Lavie A, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Characteristics and outcomes among pregnant women with end-stage renal disease on hemodialysis. J Matern Fetal Neonatal Med 2021; 35:5897-5903. [PMID: 34030571 DOI: 10.1080/14767058.2021.1900106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Pregnancy among women with end-stage renal disease (ESRD) has risen in frequency, which may be attributed to improvements in hemodialysis care. Our objective was to describe baseline characteristics and pregnancy outcomes among women with ESRD on hemodialysis. METHODS Using the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we created a cohort of women with ESRD on hemodialysis who gave birth between 2005 and 2015. We determined the proportion of adverse maternal and neonatal outcomes among this cohort. Then, we created a composite measure of vascular-mediated adverse pregnancy outcomes. Women who experienced at least one of either preeclampsia, intrauterine growth restriction, or intrauterine fetal death were categorized as having the composite measure. Then, multivariate regression models were used to estimate the associations between maternal baseline demographic and clinical characteristics and the composite measure. RESULTS Among 8,765,973 deliveries between 2005 and 2015, 307 were to women with ESRD on hemodialysis. Over the study period, the incidence of pregnancies to women with ESRD increased from 0.47 to 5.76/100,000 births. An estimated 28% of pregnancies were complicated by preeclampsia, 8% by placental abruption, 58% delivered by cesarean, and in the postpartum, 28% required blood transfusions and 6% experienced sepsis. About 45% of babies were born preterm and 14% had IUGR. The composite measure of adverse events was not found to be associated with any baseline maternal characteristics. CONCLUSIONS The frequency of pregnant women with ESRD on hemodialysis has risen, with adverse pregnancy complications for both mother and fetus. Transfer to high-risk centers is suggested for women with ESRD.
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Affiliation(s)
- Anat Lavie
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
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Kumakura S, Okamoto K, Takeuchi S, Yoshida M, Nakamichi T, Nagasawa T, Fujikura E, Yamamoto T, Saito M, Hanita T, Satoh M, Sato H, Ito S, Harigae H, Miyazaki M. Kidney function, blood pressure and proteinuria were associated with pregnancy outcomes of pregnant women with chronic kidney disease: a single-center, retrospective study in the Asian population. Clin Exp Nephrol 2020; 24:547-556. [PMID: 32162117 DOI: 10.1007/s10157-020-01865-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Studies among pregnant Asian women with chronic kidney disease (CKD) have not been widely performed; therefore, clinical criteria for these patients have not been well established. METHODS We conducted a retrospective study among pregnant women with CKD who received prenatal care at our institution for 8 consecutive years. Primary outcome was the development of severe adverse events (SAEs). We analyzed correlations between primary outcome and CKD parameters [age, body mass index (BMI), estimated glomerular filtration rate (eGFR), urinary protein-creatinine ratio (UP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and not normal blood pressure (non-NBP)] at the time of referral. Secondary outcomes were low birth weight (LBW), preterm delivery (PreD), and small for gestational age (SGA). We divided into two categories, CKD stage G1, and G2 or higher according to eGFR, and proteinuria negative and proteinuria positive according to UP, respectively. RESULTS We observed 89 pregnancies. SAE was observed in 28 pregnancies. In live birth cases, there were 28 PreD, 28 LBW and 13 SGA. Major SAEs included preeclampsia, superimposed preeclampsia, unscheduled cesarean section, neonatal intensive care unit admission, and fetal death. Stepwise logistic regression analysis selected eGFR (OR = 0.847, p = 0.026), SBP (OR = 1.897, p = 0.006) and proteinuria positive (OR = 2.96, p = 0.046) as the significant predictors of SAEs. There were no significant differences among the baseline characteristics stratified by SGA. CONCLUSIONS This is the first study to report pregnancy outcomes among Japanese non-disease-oriented patients with CKD. In Asians, especially in the Japanese population, kidney function, blood pressure and proteinuria might affect pregnancy outcomes.
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Affiliation(s)
- Satoshi Kumakura
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Division of Blood Purification, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Koji Okamoto
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Saeko Takeuchi
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Mai Yoshida
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Takashi Nakamichi
- Department of Nephrology, Ishinomaki Red-Cross Hospital, 71 Hebita-Aza-Nishinomichishita, Ishinomaki, Miyagi, 986-8255, Japan
| | - Tasuku Nagasawa
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Emi Fujikura
- Division of Blood Purification, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tae Yamamoto
- Department of Internal Medicine, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Aoba-ku, Sendai, Miyagi, 980-8502, Japan
| | - Masatoshi Saito
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Takushi Hanita
- Department of Pediatrics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8536, Japan
| | - Hiroshi Sato
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Department of Internal Medicine, JR Sendai Hospital, 1-1-5 Itsutsubashi, Aoba-ku, Sendai, Miyagi, 980-0022, Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Department of Medicine, Katta General Hospital, 36 Fukuokakuramoto-Aza-Shimookibara, Shiroishi, Miyagi, 989-0231, Japan
| | - Hideo Harigae
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. .,Division of Blood Purification, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
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Matsuo N, Nakayama Y, Inoue H, Izumi Y, Mukoyama M. 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. Ren Replace Ther 2019. [DOI: 10.1186/s41100-019-0227-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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9
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Alix PM, Brunner F, Jolivot A, Doret M, Juillard L. Twin pregnancy in a patient on chronic haemodialysis who already had three pregnancies. J Nephrol 2018; 32:487-490. [PMID: 30478508 DOI: 10.1007/s40620-018-0555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/13/2018] [Indexed: 11/29/2022]
Abstract
Pregnancy in women with end-stage renal disease is rare. Multiple pregnancies carry a high risk of complications even in healthy individuals. We report the case of a 36-year-old woman who had four pregnancies while she was on dialysis, including one twin pregnancy. The last pregnancy occurred while in the 14th year of hemodialysis. At 8 weeks of gestation (WG), ultrasonography diagnosed a dichorionic diamniotic twin pregnancy. The frequency of dialysis was increased from 3 to 6 times a week and each session lasted 4 h. At 22 WG, polyhydramnios was diagnosed. At 25 WG, the patient presented respiratory distress and was transferred to intensive care where continuous hemodialysis, non-invasive ventilation, antibiotic and tocolysis were initiated. Because of tocolysis failure, a cesarean section was performed and she delivered male twins. The two newborns weighed 790 and 870 g, respectively. To our knowledge, this is the first report of four pregnancies in hemodialysis including one twin pregnancy. The incidence of pregnancy and a better outcome in patients on hemodialysis has increased in recent years but a tight coordination between nephrologists and obstetricians is essential.
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Affiliation(s)
- Pascaline M Alix
- Department of Nephrology, Dialysis and Hypertension, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003, Lyon, France.
| | - Flora Brunner
- Department of Nephrology, Dialysis and Hypertension, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003, Lyon, France
| | - Anne Jolivot
- Department of Nephrology, Dialysis and Hypertension, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003, Lyon, France
| | - Muriel Doret
- Department of Obstetrics and Gynaecology, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Lyon, France
| | - Laurent Juillard
- Department of Nephrology, Dialysis and Hypertension, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69003, Lyon, France
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Abstract
Although kidney disease impacts on fertility, increasing numbers of pregnancies are reported in women on dialysis. Despite a trend of increasing live birth rates over recent decades, pregnancies on dialysis remain high risk with increased rates of adverse pregnancy outcomes including pregnancy loss, pre-eclampsia, pre-term delivery, low birth weight and higher levels of neonatal care. This article describes the prevalence of dialysis and pregnancy in women of childbearing age, with relevant information regarding the effects of end-stage renal disease on fertility in women. Pregnancy outcomes for women on dialysis are summarised, including their association with dialysis intensity. A guide to pre-pregnancy counselling, and the management of pregnancy on dialysis is provided. Factors that inform the decision to commence dialysis in pregnancy are examined. The advantages and disadvantages of peritoneal dialysis in pregnancy are discussed.
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Affiliation(s)
- Kate Wiles
- Department of Women and Children's Health, King's College London and the Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London SE1 7EH, United Kingdom.
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