Successful multidisciplinary experience: Pregnancy of patient with chronic kidney disease and hemodialysis
Main Article Content
Keywords
Pregnancy, High-Risk, Chronic Kidney Disease, Hemodialysis, Patient Care Team
Abstract
Introduction: Every pregnancy in patients on dialysis therapy presents a high risk for the mother and fetus. Therefore, it is recommended that the decision to become pregnant be supported by a multidisciplinary and specialized healthcare team.
Objective: To share the successful experience of multidisciplinary work in the care of a pregnant woman with chronic kidney disease and hemodialysis treatment.
Clinical case: A 35-year-old woman with systemic arterial hypertension, chronic kidney disease, and renal hypoplasia was on hemodialysis (2022). She was 20 weeks pregnant. During pregnancy, she received hemodialysis sessions 6 days per week, lasting 3 hours/day. Follow-up by nursing staff included echocardiogram studies, and obstetric ultrasound to assess maternal-fetal hemodynamic status and placental flow. The patient's outcome was satisfactory, with delivery of the baby via cesarean section at 38 weeks' gestation, with no obstetric or fetal complications.
Conclusions: The possibility of successful pregnancy in patients with chronic kidney disease and hemodialysis increases with specialized multidisciplinary collaboration. Increased dialysis time results in prolonged pregnancy, greater fetal weight, and better hemodynamic and biochemical control of the mother.
References
Piccoli GB, Minelli F, Versino E, Cabiddu G, Attini R, Vigotti FN, Rolfo A, Giuffrida D, Colombi N, Pani A, Todros T. Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrol Dial Transplant. 2016 Nov;31(11):1915-1934. doi: 10.1093/ndt/gfv395. Epub 2015 Nov 27. PMID: 26614270.
Eskandar J, Lucas A, Dixon A, Kendrick J. Pregnancy and Family Planning in Women With Kidney Disease. Kidney Int Rep. 2024 Mar 6;9(5):1236-1243. doi: 10.1016/j.ekir.2024.02.1438. PMID: 38707798; PMCID: PMC11068963.
Bansal N. Management of Pregnancy in Persons with Kidney Failure Treated with Hemodialysis. Clin J Am Soc Nephrol. 2023 Aug 1;18(8):1098-1100. doi: 10.2215/CJN.0000000000000169.
Furaz-Czerpak KR, Fernández-Juárez G, Moreno-de la Higuera MÁ, Corchete-Prats E, Puente-García A, Martín-Hernández R. Pregnancy in women on chronic dialysis: a review. Nefrologia. 2012 May 14;32(3):287-94. English, Spanish. doi: 10.3265/Nefrologia.pre2012. Jan.11319. Epub 2012 Feb 28. PMID: 22508145.
Kattah A. The Placenta Effect: Risk Factors for Adverse Fetal Outcomes in Pregnant Dialysis Patients. Kidney Int Rep. 2018 Jun 30;3(5):1017-1019. doi: 10.1016/j.ekir.2018.06.008. PMID: 30197964; PMCID: PMC6127452.
De Souza L, Pham D, Craven AM, Sekar R, Jesudason S, Ratanjee S, Walker W, Ranganathan D. Pregnancy in women on dialysis - A case series - Challenges in achieving evidence-based care. Obstet Med. 2024 Jun 5:1753495X241254243. doi: 10.1177/1753495X241254243. Epub ahead of print. PMID: 39553193; PMCID: PMC11563547.
Luders C, Castro MC, Titan SM, De Castro I, Elias RM, Abensur H, Romão JE Jr. Obstetric outcome in pregnant women on long-term dialysis: a case series. Am J Kidney Dis. 2010 Jul;56(1):77-85. doi: 10.1053/j.ajkd.2010.01.018. Epub 2010 Apr 10. PMID: 20382457.
Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M, Tennankore K, Keunen J, Hui D, Chan CT. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol. 2014 May;25(5):1103-9. doi: 10.1681/ASN.2013080825. Epub 2014 Feb 13. PMID: 24525032; PMCID: PMC4005313.
Rivera JCH, Pérez López MJ, Corzo Bermúdez CH, García Covarrubias L, Bermúdez Aceves LA, Chucuan Castillo CA, Mendoza MS, Piccoli GB, Sierra RP. Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country. J Clin Med. 2019 Apr 8;8(4):475. doi: 10.3390/jcm8040475. PMID: 30965626; PMCID: PMC6518183.
Asamiya Y, Otsubo S, Matsuda Y, Kimata N, Kikuchi KAN, Miwa N, Uchida K, Mineshima M, Mitani M, Ohta H, Nitta K, Akiba T. The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int. 2009 Jun;75(11):1217-1222. doi: 10.1038/ki.2009.48. Epub 2009 Feb 25. PMID: 19242506.
Hayet Baouche, Jean-Philippe Jais, Samy Meriem, Mimi Kareche, Olivier Moranne, Cécile Vigneau, Cécile Couchoud, Pregnancy in women on chronic dialysis in the last decade (2010–2020): a systematic review, Clinical Kidney Journal, Volume 16, Issue 1, January 2023, Pages 138–150, https://doi.org/10.1093/ckj/sfac204
Sachdeva M, Barta V, Thakkar J, Sakhiya V, Miller I. Pregnancy outcomes in women on hemodialysis: a national survey. Clin Kidney J. 2017 Apr;10(2):276-281. doi: 10.1093/ckj/sfw130. Epub 2017 Jan 5. PMID: 28396746; PMCID: PMC5381241.
Loichinger MH, Broady AJ, Yamasato K, Mills E, McLemore PG, Towner D. Effect of dialysis on fetal heart rate: is inpatient admission for fetal monitoring necessary? J Matern Fetal Neonatal Med. 2017 Jun;30(11):1293-1296. doi: 10.1080/14767058.2016.1212008. Epub 2016 Aug 10. PMID: 27405251.
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.