Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

Gianfranca Cabiddu, Santina Castellino, Giuseppe Gernone, Domenico Santoro, Franca Giacchino, Olga Credendino, Giuseppe Daidone, Gina Gregorini, Gabriella Moroni, Rossella Attini, Fosca Minelli, Gianfranco Manisco, Tullia Todros, Giorgina Barbara Piccoli

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion. Methods: A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000–2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips. Main results: Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75 % may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

Original languageEnglish
Article number191
Pages (from-to)279-288
Number of pages10
JournalJournal of Nephrology
Volume28
Issue number3
DOIs
Publication statusPublished - Jun 26 2015

Keywords

  • Chronic kidney disease
  • Daily dialysis
  • Dialysis efficiency
  • Evidence based medicine
  • Hemodialysis
  • Peritoneal dialysis

ASJC Scopus subject areas

  • Nephrology

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