Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country.

Autor: Rivera JCH; Unidad de Investigación Médica en Enfermedades Nefrológicas, CMN Siglo XXI, 06720 CdMx, México. juancarloshhernandezrivera@hotmail.com., Pérez López MJ; Nephrology Service, Hospital de Especialidades CMN 'La Raza', 02990 CdMx, México. nefropelmj@yahoo.com.mx., Corzo Bermúdez CH; Nephrology Service, Hospital de Especialidades CMN 'La Raza', 02990 CdMx, México. betocb08@gmail.com., García Covarrubias L; Transplant Service, Hospital General de México, 06720 CdMx, México. asfa@live.com.mx., Bermúdez Aceves LA; Transplant Service Hospital de Especialidades CMN 'Siglo XXI', 06720 CdMx, México. lbermudeza@hotmail.com., Chucuan Castillo CA; Nephrology Service, Hospital de Especialidades CMN 'La Raza', 02990 CdMx, México. drconradochucuan@hotmail.com., Mendoza MS; Emergency Service, Hospital Regional 'Lic. Adolfo López Mateos', ISSSTE, 01030 CdMx, México. mar4mendoza@gmail.com., Piccoli GB; Centre Hospitalier Le Mans, 72000 Le Mans, France. juancarloshhernandezrivera@hotmail.com.; Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy. juancarloshhernandezrivera@hotmail.com., Sierra RP; Unidad de Investigación Médica en Enfermedades Nefrológicas, CMN Siglo XXI, 06720 CdMx, México. jrpaniaguas@gmail.com.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2019 Apr 08; Vol. 8 (4). Date of Electronic Publication: 2019 Apr 08.
DOI: 10.3390/jcm8040475
Abstrakt: Background: Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in Mexico City, with particular attention on the interference of social and cultural elements as well as resource limitations.
Material and Methods: CKD women who needed dialysis in pregnancy over the period 2002⁻2014 and had with complete demographic and outcome data were included in this retrospective study. Clinical background, renal function during pregnancy, dialysis schedule, and clinical outcomes were reviewed.
Results: Forty pregnancies in women with CKD who needed dialysis in pregnancy (39 singleton and one twin pregnancy) were studied: All patients were treated with hemodialysis. Thirty-nine patients had CKD stages 4 or 5 at referral; only one patient was of stage 3b. Dialysis was considered as indicated in the presence of fluid overload, unresponsive hypertension in the setting of advanced CKD, or when blood urea nitrogen values were increased to around 50 mg/dL. However, the initiation of dialysis was often delayed by days or weeks. The main reason for delaying the initiation of dialysis was patient (and family) refusal to start treatment. All patients were treated with thrice weekly dialysis, in 3⁻5 hour sessions, with a target urea of <100 mg/dL. The number of hours on dialysis did not impact pregnancy outcomes. Ten pregnancies ended in miscarriages (8 spontaneous), 29 in pre-term delivery, and 1 in term delivery. Fifteen women were diagnosed with preeclampsia, one with eclampsia, and one with HELLP (hemolysis, elevated liver enzymes, low platelets,) syndrome. Twenty-four of the neonates survived (77.4% of live births); six singletons and one twin died as a consequence of prematurity. Two neonates displayed malformations: cleft palate with ear anomalies and duodenal atresia.
Conclusions: CKD requiring hemodialysis in pregnancy is associated with a high frequency of complications; in the setting of delayed start and of thrice-weekly hemodialysis, dialysis schedules do not appear to influence outcomes.
Competing Interests: None of the authors has any conflict of interest to declare.
Databáze: MEDLINE
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