title: Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy.
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.
  
  
  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.
authors.affiliation: Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy.
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Cabiddu
authors.forename: Santina
authors.initials: S
authors.lastname: Castellino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gernone
authors.forename: Domenico
authors.initials: D
authors.lastname: Santoro
authors.forename: Franca
authors.initials: F
authors.lastname: Giacchino
authors.forename: Olga
authors.initials: O
authors.lastname: Credendino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Daidone
authors.forename: Gina
authors.initials: G
authors.lastname: Gregorini
authors.forename: Gabriella
authors.initials: G
authors.lastname: Moroni
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.forename: Fosca
authors.initials: F
authors.lastname: Minelli
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Manisco
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
mesh_terms: D001835:Body Weight; D003376:Counseling; D004032:Diet; D005260:Female; D006801:Humans; D007558:Italy; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007677:Kidney Function Tests / Q000592:standards; D009398:Nephrology / Q000592:standards*; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000592:standards*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects / Q000592:standards*; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome