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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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Tangirala N, Singer J, Snelling P, Wyburn K, Chadban S, Aouad L, Gracey DM. Emphysematous pyelonpehritis in a dual kidney transplant recipient. Nephrology (Carlton) 2018; 23:1064-1065. [PMID: 30362230 DOI: 10.1111/nep.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Nishanta Tangirala
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Julian Singer
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Paul Snelling
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kate Wyburn
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Steve Chadban
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Leyla Aouad
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - David M Gracey
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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