The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age

被引:98
作者
Asamiya, Yukari [1 ]
Otsubo, Shigeru [1 ]
Matsuda, Yoshio [3 ,4 ]
Kimata, Naoki [2 ]
Kikuchi, Kan
Miwa, Naoko
Uchida, Keiko [1 ]
Mineshima, Michio
Mitani, Minoru [3 ,4 ]
Ohta, Hiroaki [3 ]
Nitta, Kosaku [1 ]
Akiba, Takashi
机构
[1] Tokyo Womens Med Univ, Dept Med, Kidney Ctr, Tokyo 1628666, Japan
[2] Tokyo Womens Med Univ, Dept Blood Purificat, Kidney Ctr, Shinjyuku Ku, Tokyo 1628666, Japan
[3] Tokyo Womens Med Univ, Dept Obstet & Gynecol, Tokyo 1628666, Japan
[4] Tokyo Womens Med Univ, Maternal & Perinatal Ctr, Tokyo 1628666, Japan
关键词
birth weight; BUN level; gestational age; hemodialysis; pregnancy; DIALYSIS PATIENTS; UNITED-STATES; MANAGEMENT; WOMEN; OUTCOMES; JAPAN;
D O I
10.1038/ki.2009.48
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Most published reports indicate that intensified hemodialysis results in better pregnancy outcomes. Here we studied clinical characteristics and the outcomes of 28 pregnant women receiving hemodialysis. We found an association between maternal blood data and birth weight, and gestational age and outcomes. There were 18 surviving infants who were followed up for one year. In the others there were 4 spontaneous abortions, 1 stillbirth, 3 neonatal deaths and 2 deaths after birth. Analysis of blood chemistry for 20 pregnancies from 12 weeks of gestation until delivery showed that the average hemoglobin level was significantly higher in the group that successfully delivered than in the unsuccessful group. There were significant negative relationships between the blood urea nitrogen (BUN) level and the birth weight or gestational age in the latter cohort. A birth weight equal to or greater than 1500g or a gestational age equal to or exceeding 32 weeks corresponded to BUN levels of 48-49 mg/dl or less. Whether the low BUN is the direct cause of the improved outcome remains to be examined. Kidney International ( 2009) 75, 1217-1222; doi:10.1038/ki.2009.48; published online 25 February 2009
引用
收藏
页码:1217 / 1222
页数:6
相关论文
共 20 条
[1]  
[Anonymous], 1971, Proc. Eur. Dial. Transpl. Assoc
[2]   Pregnancy and dialysis [J].
Bagon, JA ;
Vernaeve, H ;
De Muylder, X ;
Lafontaine, JJ ;
Martens, J ;
Van Roost, G .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1998, 31 (05) :756-765
[3]   Successful pregnancies on nocturnal home hemodialysis [J].
Barua, Mournita ;
Hladunewich, Michelle ;
Keunen, Johannes ;
Pierratos, Andreas ;
McFarlane, Philip ;
Sood, Manish ;
Chan, Christopher T. .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2008, 3 (02) :392-396
[4]   Pregnancy in women who undergo long-term hemodialysis [J].
Chao, AS ;
Huang, JY ;
Lien, R ;
Kung, FT ;
Chen, PJ ;
Hsieh, PCC .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2002, 187 (01) :152-156
[5]   Pregnancy in patients on chronic dialysis: A single center experience and combined analysis of reported results [J].
Chou, Ching-Yu ;
Ting, I-Wen ;
Lin, Tzu-Hung ;
Lee, Chien-Nan .
EUROPEAN JOURNAL OF OBSTETRICS GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 2008, 136 (02) :165-170
[6]   Successful pregnancy with nocturnal hemodialysis [J].
Gangji, AS ;
Windrim, R ;
Gandhi, S ;
Silverman, JA ;
Chan, CTM .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2004, 44 (05) :912-916
[7]   Pregnancy during dialysis: case report and management guidelines [J].
Giatras, I ;
Levy, DP ;
Malone, FD ;
Carlson, JA ;
Jungers, P .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 1998, 13 (12) :3266-3272
[8]   Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: The dialysis outcomes and practice patterns study (DOPPS) [J].
Goodkin, DA ;
Bragg-Gresham, JL ;
Koenig, KG ;
Wolfe, RA ;
Akiba, T ;
Andreucci, VE ;
Saito, A ;
Rayner, HC ;
Kurokawa, K ;
Port, FK ;
Held, PJ ;
Young, EW .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2003, 14 (12) :3270-3277
[9]   A systematic approach to managing pregnant dialysis patients-the importance of an intensified haemodiafiltration protocol [J].
Haase, M ;
Morgera, S ;
Bamberg, C ;
Halle, H ;
Martini, S ;
Hocher, B ;
Diekmann, F ;
Dragun, D ;
Peters, H ;
Neumayer, HH ;
Budde, K .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2005, 20 (11) :2537-2542
[10]   Gynecologic and reproductive issues in women on dialysis [J].
Holley, JL ;
Schmidt, RJ ;
Bender, FH ;
Dumler, F ;
Schiff, M .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1997, 29 (05) :685-690