Kidney Res Clin Pract.  2016 Jun;35(2):84-89. 10.1016/j.krcp.2015.12.005.

The successful clinical outcomes of pregnant women with advanced chronic kidney disease

• Chang JY
• Jang H
• Chung BH
• Youn YA
• Sung IK
• Kim YS
• Yang CW

• KMID: 2311827
• DOI: http://doi.org/10.1016/j.krcp.2015.12.005

Abstract

BACKGROUND
Successful pregnancy outcomes in patients with advanced chronic kidney disease (CKD) are increasingly common in Western countries. However, in Korea, the available literature addressing this clinical issue is scarce.
METHODS
We reviewed 5 successful parturitions [1 patient with Stage 5 CKD and 4 with maintenance hemodialysis (HD)] at Seoul St. Mary's Hospital over 3 years and investigated changes in dialysis prescription, anemia management, and the incidence of maternal and neonatal complications.
RESULTS
There were no maternal or neonatal deaths in this cohort. The mean age at the time of conception and delivery was 35.8 ± 3.7 and 36.2 ± 3.5 years, respectively. Dialysis patients received more frequent and intensified HD during pregnancy, 20.0 ± 5.7 h/wk of HD over 5 visits with the ultrafiltration dose maintained between 1 and 2 kg per session. All patients received erythropoietin-stimulating agents and iron replacement therapy during pregnancy. The mean hematocrit was 33.1 ± 1.9% before pregnancy and was well maintained during gestation (33.9 ± 3.8% at the first trimester, 29.2 ± 4.2% at the second trimester, and 33.6 ± 8.7% at delivery). The mean gestation period was 32.7 ± 4.7 weeks, with 60% of patients experiencing premature delivery. The primary maternal complication was pre-eclampsia; 3 women developed pre-eclampsia and underwent emergency cesarean sections. Most neonatal complications were related to preterm birth.
CONCLUSION
Dialysis-related care and general clinical management improved the clinical outcome of pregnancy for patients with advanced CKD.

Keyword

Chronic kidney disease; Dialysis; Pregnancy

MeSH Terms

Anemia
Cesarean Section
Cohort Studies
Dialysis
Emergencies
Female
Fertilization
Hematocrit
Humans
Incidence
Iron
Korea
Parturition
Perinatal Death
Pre-Eclampsia
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, First
Pregnancy Trimester, Second
Pregnant Women*
Premature Birth
Prescriptions
Renal Dialysis
Renal Insufficiency, Chronic*
Seoul
Ultrafiltration
Iron