Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Nov;27(6):477-485.
doi: 10.1053/j.ackd.2020.06.001.

End-Stage Kidney Disease and Dialysis in Pregnancy

Andrea L Oliverio  1 , Michelle A Hladunewich  2
Affiliations
Review

End-Stage Kidney Disease and Dialysis in Pregnancy

Andrea L Oliverio et al. Adv Chronic Kidney Dis. 2020 Nov.

Abstract

End-stage kidney disease is associated with low fertility, with rates of conception in women on dialysis estimated at 1/100th of the general population. However, live birth rates are increasing over time in women on hemodialysis, whereas they remain lower and static in women on peritoneal dialysis. Intensification of hemodialysis, targeting a serum blood urea nitrogen <35 mg/dL or 36 hours of dialysis per week in women with no residual kidney function, is associated with improved live birth rates and longer gestational age. Even in intensively dialyzed cohorts, rates of prematurity and need for neonatal intensive care are high, upwards of 50%. Although women on peritoneal dialysis in pregnancy do not appear to be at increased risk of delivering preterm compared with those on hemodialysis, their infants are more likely to be small for gestational age. As such, hemodialysis has emerged as the preferred dialysis modality in pregnancy. Provision of specialized nephrology, obstetric, and neonatal care is necessary to manage these complex pregnancies and family planning counseling should be offered to all women with end-stage kidney disease.

Keywords: Dialysis; ESKD; Fetal; Obstetrics; Pregnancy.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Adaptations to routine prenatal and peripartum care for women with ESKD on dialysis
BUN: blood urea nitrogen; ESA: erythropoietin stimulating agent; ASA: aspirin; EDW: estimated dry weight; BPP: biophysical profile; LFTs: liver function tests; Mg: magnesium
See this image and copyright information in PMC

References

    1. Tong A, Jesudason S, Craig JC, Winkelmayer WC. Perspectives on pregnancy in women with chronic kidney disease: systematic review of qualitative studies. Nephrol Dial Transplant 2015;30:652–61. - PubMed
    1. Ramesh S, James MT, Holroyd-Leduc JM, et al. Sex Hormone Status in Women With Chronic Kidney Disease: Survey of Nephrologists’ and Renal Allied Health Care Providers’ Perceptions. Can J Kidney Health Dis 2017;4:2054358117734534. - PMC - PubMed
    1. Modesto W, Bahamondes MV, Bahamondes L. Prevalence of Low Bone Mass and Osteoporosis in Long-Term Users of the Injectable Contraceptive Depot Medroxyprogesterone Acetate. J Womens Health (Larchmt) 2015;24:636–40. - PubMed
    1. Piccoli GB, Cabiddu G, Daidone G, et al. The children of dialysis: live-born babies from on-dialysis mothers in Italy--an epidemiological perspective comparing dialysis, kidney transplantation and the overall population. Nephrol Dial Transplant 2014;29:1578–86. - PubMed
    1. Levidiotis V, Chang S, McDonald S. Pregnancy and maternal outcomes among kidney transplant recipients. J Am Soc Nephrol 2009;20:2433–40. - PMC - PubMed

Publication types

MeSH terms