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Pregnancy in chronic renal failure patients treated by hemodialysis: two case reports and a clinical review of management guidelines

  • Review Article
  • Published:
European Clinics in Obstetrics and Gynaecology

Abstract

Although unusual, pregnancy in chronic dialysis patients does occur. In fact, the percent of successful pregnancies in women on chronic dialysis may be increasing. But unfortunately, the rates for premature delivery, neonatal death, maternal hypertension, and preeclampsia in chronic pregnant dialysis patients are high. Only 50% of pregnancies result in a surviving infant and over 80% of live born infants are premature, often severely premature. The key to improving the outcome of pregnancy in dialysis patients lies in decreasing premature labor and premature rupture of membranes in the late second and early third trimester. In this article, the incidence, duration, fetal and maternal complications, and outcomes of pregnancy in women on chronic dialysis are reviewed. The management of anemia, hypertension, electrolytes, bone minerals, and acid–base parameters in this group of patients is also summarized. We review the prevalence of pregnancy and the fetal outcome in patients with end stage renal disease (ESRD) maintained on hemodialysis previously reported in the literature. Then we report two cases of chronic renal failure patients who conceived while they were on maintenance hemodialysis with successful fetal outcome. In addition to reassessing the previously reported reviews and case reports published in the literature, we propose management guidelines for this group of patients. We emphasize that the intensive interdisciplinary cooperation of nephrologists and obstetricians is imperative for the successful management of pregnancy under these conditions. We advise that all aspects of dialysis, including duration, adequacy, nutrition, anemia, calcium and phosphate metabolism and BP control need to be closely followed throughout the course of pregnancy.

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References

  1. Hou S (1999) Pregnancy in chronic renal insufficiency and end-stage renal failure. Am J Kidney Dis (33):235–252

  2. Holley JL, Reddy S (2003) Pregnancy in dialysis patients: A review of outcomes, complications, and management. Sem Dial 16(5):384–387

    Article  Google Scholar 

  3. Souqiyyeh MZ,Huraib OS, Abdul Ghayoum MS, Aswad S (1992) Pregnancy in chronic hemodialysis patients in the kingdom of Saudi Arabia. Am J Kidney Dis (3):235–238

  4. Sulaiman I (1997) Pregnancy in hemodialysis patients. Saudi J Kidney Dis Transplant (8):32–35

  5. Yoo J, Unnikrishnan D, Lwin LN, Uillanueva HJ, Tannenbeg AM (2004) Successful triplet pregnancy in a patient on chronic hemodialysis. Nephrol Dial Transplant 19:994–997

    Article  PubMed  Google Scholar 

  6. Confortini P, Galanti G, Ancona G, Giongo A, Bruschi E, Orenzini E (1971) Full term pregnancy and successful delivery in a patient on chronic hemodialysis. Proc Eur Dial Transplant Assoc (8):74–80

  7. Registration Committee of the European Dialysis and Transplant Association (1980) Successful pregnancies in women treated by dialysis and kidney transplantation. Br J Obstet Gynecol (87):839–845

  8. Toma H, TanabeK, Tokumoto T,Kobayashi C, Yagisawa T (1999) Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey. Nephrol Dial Transplant (14):1511–1516

  9. Chao A-S, Huang J-Y, Lien R, Kung F-T, Chen P-J, Hsieh PCC (2002) Pregnancy in women who undergo long-term hemodialysis. Am J Obstet Gynecol (187):152–156

  10. Okundaye I, Abrinko P, Hou S (1998) Registry of pregnancy in dialysis patients. Am J Kidney Dis (31):766–773

  11. Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, VanRoose G (1998) Pregnancy and dialysis. Am J Kidney Dis (31):756–765

  12. Holley JL, Schmidt RJ, Bender FH, Dumler F, Schi M (1997) Gynecologic and reproductive issues in women on dialysis. Am J KidneyDis (29):685–690

  13. Hou SH (1994) Frequency and outcome of pregnancy in women on dialysis. Am J Kidney Dis 23:60–63

    PubMed  CAS  Google Scholar 

  14. Tan LK, Kanagalingam D, Tan HK, Choong HL (2006) Obstetric outcomes in women with end-stage renal failure requiring renal dialysis. Int J Gynaecol Obstet 94(1):17–22 Jul

    Article  PubMed  Google Scholar 

  15. Gangi SA,Windrom R,Gandhi S (2004) Successful pregnancy with nocturnal hemodialysis. Am J kidney Dis (5):912–919

  16. Al- Wadei KH, Abu-Absa NW, Donia AF (2004) The first successful pregnancy in hemodialysis patient in Yemen. Nephrol Dial Transpant

  17. E, Akar H, UçkuyuA, Nergizoglu G, Keven K, Bakkaloglu S, Duman N, Ates K (1999) The impact of withdrawing ACE inhibitors on erythropoietin responsiveness and left ventricular hypertrophy in haemodialysis patients. J Nephrol 13:75–77

    Google Scholar 

  18. Malik GH, Al-Wakeel JS, Shaikh JF, Al-Mohaya S, Dohamii H, Kechrid M, El Gamal H (1997) Three successive pregnancies in a patient on haemodialysis. Nephrol Dial Transplant 12:1991–1993

    Article  PubMed  CAS  Google Scholar 

  19. Andre WD, Alexandra S, Saila M, Burkhard K, Hans UK, Tilman S, Rainer PW (2004) Nephrol Dial Transplant 19:1634–1636

    Article  Google Scholar 

  20. Giatras I, Levy DP, Malone FD, Carlson JA, Jungers P (1998) Pregnancy during dialysis: case report and management guidelines. Nephrol Dial Transplant 13:3266–3272

    Article  PubMed  CAS  Google Scholar 

  21. Walsh AM (2002) Management of a pregnant woman dependent on haemodialysis. EDTNA-ERCA J 28(2):91–94 Apr–Jun

    PubMed  Google Scholar 

  22. Lopez MR, Cabez B, Albero MD, Alvarez L, Sanchez L (2004) Successful pregnancy in a patient with systemic lupus erythematosus on hemodialysis. Nefrologia 24(1):70–74

    Google Scholar 

  23. Kazancioglu R, Sahin S, Has R, Turkmen A, Ergin-Karadayi H, Ibrahimoglu L, Bozfakioglu S (2003) The outcome of pregnancy among patients receiving hemodialysis treatment. Clin Nephrol 59(5):379–382

    PubMed  CAS  Google Scholar 

  24. Luciani G, Bossola M, Tazza L, Panocchia N, Liberatori M, De Carolis S, Piccioni E, De Carolis MP, Caruso A, Castagneto M (2002) Pregnancy during chronic hemodialysis: a single dialysis-unit experience with five cases. Ren Fail 24(6):853–862 Nov

    Article  PubMed  Google Scholar 

  25. Vidal ML, Ursu M, Martinez A, Roland SS, Wibmer E, Pereira D, Subiza K, Alonso W, Seijas L, Piazze S, Lisorio L, Falconi JP, Canessa R, Laborda L, Dibello N (1998) Nutritional control of pregnant women on chronic hemodialysis. J Ren Nutr 8(3):150–156 Jul

    Article  PubMed  CAS  Google Scholar 

  26. Bhatla N, Bhowmik D, Kriplani A, Agarwal N, Gupta A, Dash SC (2001) Successful pregnancy outcome in advanced chronic renal failure. J Assoc Physicians India 49:845–847 Aug

    PubMed  CAS  Google Scholar 

  27. Reister F, Reister B, Heyl W, Riehl J, Schröder W, Mann H, Rath W (1999) Dialysis and pregnancy-a case report and review of the literature. Ren Fail 21(5):533–539 Sep

    Article  PubMed  CAS  Google Scholar 

  28. Kung FT, Changchien CC, Roan CC (1994) Successful pregnancy in a chronic hemodialytic woman-a case report. Changgeng Yixue Zazhi 17(2):178–183 Jun

    CAS  Google Scholar 

  29. Ahlstrom NG, Allen SR, Tisher CC (1991) Successful pregnancy in a patient receiving hemodialysis.. South Med J 84(2):276–277 Feb

    PubMed  CAS  Google Scholar 

  30. Alcalay M, Blau A, Barkai G, Lipitz S, Mashiach S, Eliahou HE (1992) Successful pregnancy in a patient with polycystic kidney disease and advanced renal failure: the use of prophylactic dialysis. Am J Kidney Dis 19(4):382–384 Apr

    PubMed  CAS  Google Scholar 

  31. Hsieh TT, Chen KC, Cheng BJ, Chiu TH (1991) Pregnancy outcome in patients undergoing long-term hemodialysis. Acta Obstet Gynecol Scand 70(4–5):299–302

    Article  PubMed  CAS  Google Scholar 

  32. Brown MA, Farrell C, Newton P, Child RP (1990) Thalidomide, pregnancy and renal failure. Med J Aust 152(3):148–149 Feb 5

    PubMed  CAS  Google Scholar 

  33. Cohen D, Frenkel Y, Maschiach S, Eliahou HE (1988) Dialysis during pregnancy in advanced chronic renal failure patients: outcome and progression. Clin Nephrol 29(3):144–148 Mar

    PubMed  CAS  Google Scholar 

  34. Van Dam P, De Cleyn K, Couttenye M, Vervliet J, Buytaert P (1987) Renal failure in pregnancy, treated by hemodialysis. J Reprod Med 32(6):463–465 Jun

    Google Scholar 

  35. Gafter U, Peleg D, Korzets A, Zevin D, Landman J, Goldman J, Levi J (1990) Successful pregnancies in women on regular hemodialysis treatment. Isr J Med Sci 26(5):266–270 May

    PubMed  CAS  Google Scholar 

  36. Rotellar C, Ferragut A, Borrull J (1983) Pregnancy in a patient on regular hemodialysis. Nephron 35(1):66–67

    PubMed  CAS  Google Scholar 

  37. Kobayashi H, Matsumoto Y, Otsubo O, Otsubo K, Naito T (1981) Successful pregnancy in a patient undergoing chronic hemodialysis. Obstet Gynecol 57(3):382–386 Mar

    PubMed  CAS  Google Scholar 

  38. Hou SH (1994) Pregnancy in women on hemodialysis and peritoneal dialysis. Baillieres Clin Obstet Gynecol (8):481–500

  39. Hull AR (1998) More dialysis appears beneficial for pregnant ESRD patients (at least in Belgium). Am J Kidney Dis (31):863–867

  40. Jungers P,Chauveau D (1997) Pregnancy and renal disease. Kidney Int (52):871–885

  41. Shemin D (2003) Dialysis in pregnant women with chronic kidney disease. Semin Dial (16):379–383

  42. Keller F, Griesshammer M, Haussleur U, Paulus W, Schwarz A (2001) Pregnancy and renal failure: the case for application of dosage guidelines. Drugs (61):1901–1920

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Authors and Affiliations

  1. Prince Salman Center for Kidney Diseases, Riyadh, Kingdom of Saudi Arabia

    Khalid Alsaran & Alaa Sabry

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  1. Khalid Alsaran
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  2. Alaa Sabry
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Correspondence to Khalid Alsaran.

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Alsaran, K., Sabry, A. Pregnancy in chronic renal failure patients treated by hemodialysis: two case reports and a clinical review of management guidelines. Eur Clinics Obstet Gynaecol 3, 117–122 (2008). https://doi.org/10.1007/s11296-008-0074-4

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  • DOI: https://doi.org/10.1007/s11296-008-0074-4

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