Successful pregnancies in patients on chronic hemodialysis. Experience in peruvian public hospitals

  • Percy Herrera-Añazco Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud (UGES), Universidad San Ignacio de Loyola (USIL), Lima
  • Cristian León-Rabanal Universidad Peruana Cayetano Heredia (UPCH), Hospital Nacional Cayetano Heredia, Lima
  • Enrique M. Florez-Gálvez Hospital Nacional Hipólito Unanue (HNHU), Lima
Keywords: pregnancy, delivery obstetric, renal dialysis

Abstract

Reports of pregnant patients with chronic kidney disease on hemodialysis (CKDHD) with successful births are becoming more frequent. In the Ministry of Health there are no publications of official records of patients on dialysis and, therefore, data about pregnant women on dialysis are unknown. A retrospective and multicenter study was conducted on patients with CKDHD who had successful births in the public hospitals of Lima. Only 4 were found to have enough data for the report. The patients had an average age of 29 years (SD: 4.8), with an average gestation time at the end of pregnancy of 30.5 weeks (SD: 3.69). Preeclampsia was the most common complication in 2 out of 4 patients and all patients had less than 20 hours of treatment per week. The Ministry of Health should propose contingency measures for the management of these cases, which will be more and more frequent.

References

Hladunewich M, Schatell D Intensive dialysis and pregnancy. Hemodial Int. 2016;20(3):339-48.

Piccoli GB, Minelli F, Versino E, Cabiddu G, Attini R, et al. 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;31(11):1915-34.

Piccoli GB, Conijn A, Consiglio V, Vasario E, Attini R, et al. Pregnancy in dialysis patients: ¿Is the evidence strong enough to lead us to change our counseling policy? Clin J Am Soc Nephrol. 2010;5(1):62-71.

Successful pregnancies in women treated by dialysis and kidney transplantation. Report from the Registration Committee of the European Dialysis and Transplant Association. Br J Obstet Gynaecol. 1980;87(10):839-45.

Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, et al. Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison. J Am Soc Nephrol. 2014 May;25(5):1103-9.

Luders C, Castro MC, Titan SM, De Castro I, Elias RM, Abensur H, et al. Obstetric outcome in pregnant women on long-term dialysis: a case series. Am J Kidney Dis. 2010;56(1):77-85.

Reddy SS, Holley JL. Management of the pregnant chronic dialysis patient. Adv Chronic Kidney Dis. 2007;14(2):146-55.

Espinoza F, Romeo R, Ursu M, Tapia A, Vukusich A. Embarazos exitosos en hemodiálisis crónica: experiencia de un único centro. Rev Méd Chile. 2013;141(8):12-27.

Perú. Dirección General de Epidemiología. Análisis de la situación de la enfermedad renal crónica en el Perú, 2015 [Internet]. Lima: Ministerio de Salud, 2016. Disponible en: http://www.dge.gob.pe/portal/index.php?option=com_content&view=article&id=598&Itemid=353 [citado 23-09-2017]

Herrera-Añazco P, Pacheco-Mendoza J, Taype-Rondan A. La enfermedad renal crónica en el Perú. Una revisión narrativa de los artículos científicos publicados. Acta Méd Peruana. 2016;33(2):130-7.

Fitzpatrick A, Mohammadi F, Jesudason S. Managing pregnancy in chronic kidney disease: improving outcomes for mother and baby. Int J Womens Health. 2016;8:273-85.

Sachdeva M, Barta V, Thakkar J, Sakhiya V, Miller I. Pregnancy outcomes in women on hemodialysis: a national survey. Clin Kidney J. 201710(2):276-81.

Nakabayashi M, Adachi T, Itoh S, Kobayashi M, Mishina J, Nishida H. Perinatal and infant outcome of pregnant patients undergoing chronic hemodialysis. Nephron. 1999;82(1):27-31.

Giatras I, Levy DP, Malone FD, Carlson JA, Jungers P. Pregnancy during dialysis: case report and management guidelines. Nephrol Dial Transplant. 1998;13(12):3266-72.

Malik GH, Al-Harbi A, Al-Mohaya S, Dohaimi H, Kechrid M, Shetaia MS, A, et al. Pregnancy in patients on dialysis--experience at a referral center. J Assoc Physicians India. 2005;53:937-41.

Shan HY, Rana S, Epstein FH, Stillman IE, Karumanchi SA, Williams ME. Use of circulating antiangiogenic factors to differentiate other hypertensive disorders from preeclampsia in a pregnant woman on dialysis. Am J Kidney Dis. 2008;51(6):1029-32.

Akbari A, Hladunewich M, Burns K, Moretti F, Arkoub RA, Brown P, et al. Circulating angiogenic factors in a pregnant woman on intensive hemodialysis: a case report. Can J Kidney Health Dis. 2016;3:7.

Bramham K, Seed PT, Lightstone L, Nelson-Piercy C, Gill C, Webster P, et al. Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease. Kidney Int. 2016;89(4):874-85.

Leduc V, Ficheux M, Bechade C, Dreyfus M, Lobbedez T, Henri P. Pregnancy on short-daily home hemodialysis using low dialysate flow rate: A new hope for the end-stage renal disease patients. Hemodial Int. 2018;22(2):161-7.

Bernasconi A, Waisman R, Beresan M, Lapidus A, Canteli M, Heguilén R. Pregnancy: Intensified hemodialysis yes or no? Nephrol Dial Transplant. 2012;27(Suppl 2):ii281.

Cabiddu G, Castellino S, Gernone G, Santoro D, Giacchino F, Credendino O, et al. Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy. J Nephrol. 2015;28(3):279-88.

Asamiya Y, Otsubo S, Matsuda Y, Kimata N, Kikuchi KAN, Miwa N, et al. The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int. 2009;75(11):1217-22.

Mackay EV. Pregnancy and renal disease. A ten-year survey. Aust N Z J Obstet Gynaecol. 1963;3:21-34.

National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884-930.

Francis ER, Allen AK, Herrera-Añazco P, Kuo CC, Cardenas MK, Feldman HI, et al. Establishing a higher priority for chronic kidney disease in Peru. Lancet Glob Health. 2016;4(1):e17-8.

Hou S. Conception and pregnancy in peritoneal dialysis patients. Perit Dial Int. 2001;21 (Suppl 3):S290-4.

Hou S. Pregnancy in dialysis patients: where do we go from here? Semin Dial. 2003;16(5):376-8.

Izquierdo-Saona A, Gallo-Carrillo T, Bellido-Boza L, Herrera-Añazco P, Mezones-Holguin E. Deficiencies in prescription and access to diet-based treatment of chronic kidney disease in hemodialysis: a glimpse into the context of inequity. Rev Peru Med Exp Salud Pública. 2013;30(4):714-5.

Published
2018-12-14
How to Cite
1.
Herrera-Añazco P, León-Rabanal C, Florez-Gálvez EM. Successful pregnancies in patients on chronic hemodialysis. Experience in peruvian public hospitals. Rev Nefrol Dial Traspl. [Internet]. 2018Dec.14 [cited 2024Jul.16];38(4):273-9. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/374
Section
Case Report