Dialysis on Pregnancy: An Overview

Roberta Costanza Bruno Vecchio,Giovanna Savastano,Maria Grazia Porpora,Valentina Del Negro,Maria Grazia Piccioni

doi:10.3390/women1010005

Roberta Costanza Bruno Vecchio, Giovanna Savastano + Show 3 more

Open Access

https://doi.org/10.3390/women1010005

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Journal: Women	Publication Date: Jan 29, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: Sapienza University of Rome

Abstract

Pregnancy rates in women on dialysis have increased in the last decades, thus making it a topic of growing interest. The rarity of this event is predominantly due to fertility problems and to the high rates of pregnancy failure including stillbirth, fetal, and neonatal deaths. We conducted a narrative review of existing literature in order to analyze the major issues about pregnancy on dialysis to give the reader a fully updated perspective about this topic which, even if not common, is becoming more and more frequent. Even if recently acquired knowledge has improved diagnosis and treatment of dialysis pregnancies focusing on several aspects, pregnancy on dialysis remains a great challenge for obstetricians and should be managed by a multidisciplinary expertise team. Dialysis in pregnancy may be necessary for women previously affected by end stage renal disease (ESRD) becoming pregnant, or in case of acute renal injury presenting for the first time during gestation or, again, in case of existent renal pathology worsening during pregnancy and requiring dialysis. Although some evidence suggests that more intensive dialysis regimens are correlated with better obstetric outcomes, the optimal therapeutic protocol still remains to be established.

Highlights

Pregnancy in women on dialysis is not common, but is becoming increasingly topical
The majority of women with renal insufficiency pursue pregnancy at more advanced ages and can be afflicted by underlying diseases [2]. These women represent a population of high risk-patient, with increased rates of adverse pregnancy outcomes, including abortion, preeclampsia, preterm delivery, fetal growth restriction, low birth weight and higher frequency of neonatal intensive care unit admissions [3]
Since the first successful case of pregnancy on hemodialysis described in 1971 by Confortini et al [4], the incidence of pregnancies complicated by chronic kidney disease (CKD) is becoming more and more frequent and increasingly being encountered in obstetrical practice

Summary

Introduction

Pregnancy in women on dialysis is not common, but is becoming increasingly topical. The rarity of this event is predominantly due to fertility problems and to the high rates of pregnancy failure including stillbirth, fetal and neonatal deaths [1]. The majority of women with renal insufficiency pursue pregnancy at more advanced ages and can be afflicted by underlying diseases [2] These women represent a population of high risk-patient, with increased rates of adverse pregnancy outcomes, including abortion, preeclampsia, preterm delivery, fetal growth restriction, low birth weight and higher frequency of neonatal intensive care unit admissions [3]. Literature evidence suggests a six-fold increase of the number of dialysis pregnancies from the years 2000–2008 compared to the years 2008–2014 [6], even though the probability of becoming pregnant for this group of women is about 1:100 if compared to the general population of the same age [7] This increment of cases could be related to improved medical care, in particular intensive

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