A systematic approach to managing pregnant dialysis patients—the importance of an intensified haemodiafiltration protocol

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2005-11, Vol.20 (11), p.2537-2542
• Main Authors: Haase, Michael, Morgera, Stanislao, Bamberg, Christian, Halle, Horst, Martini, Sebastian, Hocher, Berthold, Diekmann, Fritz, Dragun, Duska, Peters, Harm, Neumayer, Hans-H., Budde, Klemens
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Glomerulonephritis; Glomerulonephritis - blood; Glomerulonephritis - therapy; haemodiafiltration; Hemodiafiltration - methods; Hemoglobins - metabolism; Humans; Infant, Newborn; Intensive care medicine; Length of Stay; Medical sciences; multidisciplinary management; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Urea - blood
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfi044

Background. Pregnancy is still uncommon in women on maintenance dialysis; and their outcomes is reported to have improved to 40% to 85% live births. Here, we report the successful multidisciplinary management of five consecutive pregnant dialysis patients. Methods. In our centre, we treated each of five patients with a systematically intensified haemodiafiltration protocol, increased erythropoeitin dosages, a generous administration of water-soluble vitamins and trace elements, and a multidisciplinary clinical management approach with a very low threshold for hospitalization. Results. All patients received haemodiafiltration at least 6 times/week, an average of 28.6±6.3 h/week. We achieved a mean weekly Kt/Vdp of 9.6±1.4 and urea reduction rates of 54.8±29.4%. The mean erythropoeitin dose was increased from 169±94 IU/kg/week prior to admission at our centre to 314±111 IU/kg/week after the initiation of intensified haemodiafiltration. Haemoglobin levels increased from 8.9±1.9 g/dl to 10.7±0.5 g/dl. Mean gestational age at delivery was 32.8±3.3 weeks and mean birth weight was 1765±554 g. The length of hospital stay amounted to 85±61 days for the mothers and 26±18 days for the newborns, and all were discharged healthy. Conclusions. These modified management guidelines led to favourable outcomes in all our patients, and may help to guide therapy in other pregnant dialysis patients.