Pregnancy among Women undergoing Chronic Hemodialysis
The pregnancy is told as a rare event among End-stage Renal Disease (ESRD) women undergoing chronic Hemodialysis (HD). This is mainly due to ESRD to be considered per se as a powerful method of contraception and sexual dysfunction is higher in women undergoing HD likely as a result of the cumulative effects of depression, fatigue, altered body image, medication side effects, and premature menopause, and the gestation in these women is frequently associated with poor fetal outcomes. However, in the last years the number of gestations among patients undergoing HD is increasing exponentially around the world, associated with better fetal outcomes secondary to improvement in dialysis management during gestation. A systematic review and meta-analysis in pregnancy on dialysis patients regarding the period between 2000 and 2008 collected series of at least 5 cases included 90 pregnancies and when the period was increased in 6 years (from 2000 to 2014) more than 600 pregnancies were included, probably related to the great progress that has been made in the care of HD patients with widespread use of biocompatible membranes, greater dialysis dose, and erythropoiesis-stimulating agents.
The goal is to perform HD without UF during pregnancy. However, it is difficult to obtain, even with intensive HD, once most weight gain in the interdialytic period is of fluid. In our study, the patient performed to 122 HD sessions after admission in our renal unit and UF was necessary for all HD session . The acute effect of UF in placental-fetal blood flow was studied when UF volume was ≥ 2000 mL (2.18 ± 0.25 L)/HD session with UF rate 6~8 mL/h/kg and doppler velocimetric parameters (pulsatility index and resistance index) before and after UF in this gestational period were compared with reference value in normal pregnancy (5th,50th and 90th percentile) to the same gestational age and we demonstrated that UF rate: 6~8 mL/h/kg did not bring any acute harmful effect on placental-fetal blood flow.
Pregnancy is possible among women undergoing chronic HD and obstetric and nephrological medical care must be beginning before the conception. Intensive HD regimen with adequate dialysate during gestation plays a critical role to promote better control of milieu uremic, anaemia, maternal volemia and better fetal outcome. UF during HD is a modifiable fetal risk factor and a higher UF rate may lead to placental ischemic injury and predispose to fetal distress. When UF is prescribed during gestation it should be individualized, done cautiously and with a lower rate as possible in order to avoid the acute or chronic fetal deleterious effect.
Journal of Clinical Nephrology and Therapeutics