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

Abstract

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.