End-stage renal disease and pregnancy.
Pregnancy in patients with ESRD is rare and remains especially challenging. Because endocrine abnormalities and sexual dysfunction decrease fertility, conception rates have been remarkably low in this patient population. Moreover, when pregnancy does occur, hypertension, preeclampsia, anemia, intrauterine growth restriction, preterm delivery, stillbirth, and other complications can decrease the rate of a successful outcome. However, recent experiences with intensive hemodialysis managed by a multidisciplinary team are encouraging with respect to better overall outcomes for mothers and infants. In this article, we discuss the main causes of decreased fertility in dialysis-dependent women, review outcomes and complications of pregnancy among dialysis patients with a special focus on recent intensive hemodialysis data, and summarize the current best strategy to manage pregnant women on dialysis.
Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Annie-Claire
AC
Nadeau-Fredette
Michelle
M
Hladunewich
Dini
D
Hui
Johannes
J
Keunen
Christopher T
CT
Chan
D000740:Anemia / Q000628:therapy; D005260:Female; D005317:Fetal Growth Retardation / Q000517:prevention & control; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000628:therapy*; D011225:Pre-Eclampsia / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011250:Pregnancy Complications, Hematologic / Q000628:therapy; D047928:Premature Birth / Q000517:prevention & control; D006435:Renal Dialysis / Q000379:methods; D050497:Stillbirth; D013997:Time Factors