title: Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison.
abstract: Pregnancy is rare in women with ESRD and when it occurs, it is often accompanied by significant maternal and fetal morbidity and even mortality. Preliminary data from the Toronto Nocturnal Hemodialysis Program suggested that increased clearance of uremic toxins by intensified hemodialysis improves pregnancy outcomes, but small numbers and the absence of a comparator group limited widespread applicability of these findings. We compared pregnancy outcomes from 22 pregnancies in the Toronto Pregnancy and Kidney Disease Clinic and Registry (2000-2013) with outcomes from 70 pregnancies in the American Registry for Pregnancy in Dialysis Patients (1990-2011). The primary outcome was the live birth rate and secondary outcomes included gestational age and birth weight. The live birth rate in the Canadian cohort (86.4%) was significantly higher than the rate in the American cohort (61.4%; P=0.03). Among patients with established ESRD, the median duration of pregnancy in the more intensively dialyzed Toronto cohort was 36 weeks (interquartile range, 32-37) compared with 27 weeks (interquartile range, 21-35) in the American cohort (P=0.002). Furthermore, a dose response between dialysis intensity and pregnancy outcomes emerged, with live birth rates of 48% in women dialyzed ≤20 hours per week and 85% in women dialyzed >36 hours per week (P=0.02), with a longer gestational age and greater infant birth weight for women dialyzed more intensively. Pregnancy complications were few and manageable. We conclude that pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis.
authors: Department of Medicine, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; michelle.hladunewich@sunnybrook.ca.
authors: Michelle A
authors: MA
authors: Hladunewich
authors: Department of Medicine, Division of Nephrology, Loyola University Medical Center, Maywood Illinois;
authors: Susan
authors: S
authors: Hou
authors: Department of Medicine, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;
authors: Ayodele
authors: A
authors: Odutayo
authors: Department of Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands;
authors: Tom
authors: T
authors: Cornelis
authors: Department of Medicine, Division of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada;
authors: Andreas
authors: A
authors: Pierratos
authors: Department of Medicine, Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada;
authors: Marc
authors: M
authors: Goldstein
authors: Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada;
authors: Karthik
authors: K
authors: Tennankore
authors: Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada; and.
authors: Johannes
authors: J
authors: Keunen
authors: Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Dini
authors: D
authors: Hui
authors: Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada;
authors: Christopher T
authors: CT
authors: Chan
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D012042:Registries; D006435:Renal Dialysis; D014481:United States