Pregnancy in End Stage Renal Disease

CURRENT STATUS OF ALTERNATIVE HEMODIALYSIS REGIMENS
Pregnancy in End Stage Renal Disease
Michelle Hladunewich1,3, Adam Engel Hercz1, Johannes Keunen2, Christopher Chan3, Andreas Pierratos4
Article first published online: 29 NOV 2011

DOI: 10.1111/j.1525-139X.2011.00996.x

© 2011 Wiley Periodicals, Inc.
Issue
Seminars in Dialysis

Early View (Online Version of Record published before inclusion in an issue)

Abstract
The ovulatory menstrual cycle is known to be affected on multiple levels in women with advanced renal disease. Menstrual irregularities, sexual dysfunction, and infertility worsen in parallel with the renal disease. Pregnancy in women with ESRD on dialysis is therefore uncommon. Furthermore, when pregnancy does occur, it can prove hazardous to both mother and baby owing to a multitude of potential complications including accelerated hypertension and preeclampsia, poor fetal growth, anemia, and polyhydramnios. Data are emerging, however, to suggest that pregnancy while on intensified renal replacement regimens may result in better pregnancy outcomes, and emerging trends include the decreased rate of therapeutic abortions probably reflecting a change in counseling practices over time. Nevertheless, a pregnant woman on intensive dialysis requires meticulous follow-up by a dedicated team including nephrology, obstetrics, and a full multidisciplinary staff. In this article, we will address fertility issues in young women with ESRD, review pregnancy outcomes in women on both hemodialysis and peritoneal dialysis, and provide suggestions for the management of the pregnant women on intensive hemodialysis.

http://onlinelibrary.wiley.com/doi/10.1111/j.1525-139X.2011.00996.x/abstract