SAT-219 OUTCOMES OF PREGNANCY AMONG CHRONIC HEMODIALYSIS PATIENTS

Abstract

Pregnancy in end stage renal disease (ESRD) women is uncommon and the risk for maternal - fetal complications is high. The rate of successful pregnancies in chronic hemodialysis (HD) patients has improved over the last decade up to 80%. Multidisciplinary team care and intensified hemodialysis regimens contributed in this substantial impact. We are reporting the outcomes of pregnancy in hemodialysis patients from single hemodialysis center in United Arab Emirates. A retrospective chart review study was conducted at Tawam hospital hemodialysis unit (capacity of 380 patients) over 10 years (Jan 2009 – June 2019). We included all cases of female HD patients get pregnant during study period. Demographic, clinical and laboratory data were collected as well as pregnancy outcomes, maternal and fetal complications were analyzed using descriptive analysis. we identified a total of 5 female ESRD patients on HD, with a total of 7 pregnancies. The mean age was 35.5 years. Three patients were expatriates. The causes of ESRD were type 1 diabetes (2), type 2 diabetes (1), systemic lupus erythematosus (1) and adult polycystic kidney disease (1). Other comorbid conditions were anemia of renal disease (5), hypertension (4), dyslipidemia (4), obesity (2), history of ischemic heart disease (IHD) (1) and peripheral vascular disease (PVD) (1). The average duration on hemodialysis at time of pregnancy was ranging from 3 months to 7 years and two patients were initiated on HD in the first 10 weeks of pregnancy. Three patients were multiparous prior to ESRD, with total number of children (11) and abortion/ fetal death (7). All the 5 patients had spontaneous pregnancies. The frequency of HD increased to 5-6 times per week with 4 hours duration with average pre-dialysis urea levels of 10.5 to 12 mmol/L Qutaiba Hussain*,. The maternal complications during pregnancy in our cohort including: urinary tract infection (1), diabetic foot infection (1), anemia required blood transfusion (3), renal cyst rupture (1), recurrent arteriovenous graft thrombosis (1), preeclampsia (3), premature preterm rapture of membrane (PPROM) and abruptio placenta (2). The successful outcomes of pregnancies were three live births required c sections for preterm delivery at 30 – 34 weeks (2 emergency c/sections for preeclampsia and abruptio placenta). A patient had advanced diabetic type 1 complications with IHD, PVD had a total of 3 pregnancies with poor outcomes due to uteroplacental insufficiency (one fetal death at 25 weeks, one severe intrauterine growth restriction (IUGR)/preeclampsia, and one with PPROM/ IUGR). The fetal complications identified were preterm delivery (3), fetal death (1), post-delivery death (2), severe IUGR (3), abortion (1) and fetal anomalies (2) [anhydramnios (1), membranous ventricular septal defect VSD (1)]. Pregnancy in chronic hemodialysis patients with advanced comorbid conditions has high risk for complications and need comprehensive care. We had a total of 7 pregnancies over 10 years with successful outcomes in three patients (42.8%).