Pregnancy in women who undergo long-term hemodialysis

OBJECTIVE: Pregnancy is rare in women who require long-term hemodialysis, and pregnancy outcome with a live birth has a low success rate. The purpose of this study was to describe the treatment of pregnancy and the outcome in a series of patients undergoing long-term hemodialysis treatment. STUDY DESIGN: A total of 15 women who were undergoing long-term hemodialysis treatment who had 18 pregnancies during the period from 1990 to 2000 were included in this study. All the women had been undergoing hemodialysis for a mean of 5.3 years before pregnancy, except for one woman who began hemodialysis at 16 weeks of gestation. When conception was confirmed, the risks of pregnancy were explained to the couple and to the medical team. Almost all hemodialysis were performed with a high-flux dialyzer and with volume-controlled ultrafiltration. During pregnancy the hemodialysis schedule was increased to 4 hours 4 to 6 times weekly, with a blood flow rate of 250 to 300 mL/min and a dialysate flow rate of 500 to 600 mL/min. Data on changes in dialysis regimen, biochemistry, blood pressure control, use of erythropoietin, medical complications, obstetric regimen, and perinatal problems were collected. RESULTS: Elective abortion was performed in 5 of the 18 pregnancies. Thirteen pregnancies were treated, with 12 live births, of which 9 infants survived. There was 1 intrauterine fetal death and 3 neonatal deaths. No fetal anomaly was detected. The mean gestational age at delivery was 32 weeks (range, 23-36 weeks). The mean newborn weight was 1542 g (range, 512-1660 g), with intrauterine growth restriction in 7 of the 9 cases. Anemia was treated with recombinant human erythropoietin and/or transfusion in all cases, Of the 15 women undergoing hemodialysis treatment, elevated blood pressure was complicated in 13 pregnancies, in which 7 were treated with antihypertensive drugs. Polyhydramnios occurred in 6 of 9 surviving live births and was partially relieved after hemodialysis. Cesarean delivery was performed in 6 of 13 deliveries. All of the women recovered after delivery to their prepregnancy dialysis therapy levels. CONCLUSION: Although pregnancy remains risky in women who are undergoing long-term dialysis, advances in dialysis, obstetrics, and neonatal treatment have led to an improved success rate. Our data from 1990 to 2000 showed a 60% success rate.