Clinical Case 65: Answers and Summary

A 34 YEAR OLD FEMALE ON HEMODIALYSIS GETS PREGNANT. HOW WOULD YOU ADJUST THE PRESCRIPTION ON DIALYSIS TO HAVE THE BEST OUTCOME FOR MOTHER AND BABY?

Change to Peritoneal dialysis

  7 (9%)

 

Since the largest data suggests poor outcomes, would suggest to not continue pregnancy

  2 (2%)

 

Daily dialysis for total of 12-15 hours per week

  38 (50%)

 

Three times a week dialysis as her regular prescription

  6 (7%)

 

Three times a week dialysis but goal pre-dialysis BUN<35-40mg/dl

  23 (30%)

 

Pregnancy has been reported in dialysis patients. Over 70% of 80 pregnancies reported in one large series, had resulted in surviving infants and no maternal deaths. The largest case series to date of pregnant HD patients is 52 patients over 20 years. In that experience, HD was performed daily but total weekly treatments were shorter( 12-15 hours per week). UF was avoided and over 85% of pregnancies ended up with surviving infants. Most were pre terms. BUN concentration is <35mg/dl. In other words, pregnancy can be successfully tried in HD patients in the right circumstances and in the experienced centers. Most answered the question correctly.