The successful clinical outcomes of pregnant women with advanced chronic kidney disease.
10.1016/j.krcp.2015.12.005
- Author:
Ji Yeun CHANG
1
;
Hanbeol JANG
;
Byung Ha CHUNG
;
Young Ah YOUN
;
In Kyung SUNG
;
Yong Soo KIM
;
Chul Woo YANG
Author Information
1. Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. yangch@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Chronic kidney disease;
Dialysis;
Pregnancy
- MeSH:
Anemia;
Cesarean Section;
Cohort Studies;
Dialysis;
Emergencies;
Female;
Fertilization;
Hematocrit;
Humans;
Incidence;
Iron;
Korea;
Parturition;
Perinatal Death;
Pre-Eclampsia;
Pregnancy;
Pregnancy Outcome;
Pregnancy Trimester, First;
Pregnancy Trimester, Second;
Pregnant Women*;
Premature Birth;
Prescriptions;
Renal Dialysis;
Renal Insufficiency, Chronic*;
Seoul;
Ultrafiltration
- From:Kidney Research and Clinical Practice
2016;35(2):84-89
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Successful pregnancy outcomes in patients with advanced chronic kidney disease (CKD) are increasingly common in Western countries. However, in Korea, the available literature addressing this clinical issue is scarce. METHODS: We reviewed 5 successful parturitions [1 patient with Stage 5 CKD and 4 with maintenance hemodialysis (HD)] at Seoul St. Mary's Hospital over 3 years and investigated changes in dialysis prescription, anemia management, and the incidence of maternal and neonatal complications. RESULTS: There were no maternal or neonatal deaths in this cohort. The mean age at the time of conception and delivery was 35.8 ± 3.7 and 36.2 ± 3.5 years, respectively. Dialysis patients received more frequent and intensified HD during pregnancy, 20.0 ± 5.7 h/wk of HD over 5 visits with the ultrafiltration dose maintained between 1 and 2 kg per session. All patients received erythropoietin-stimulating agents and iron replacement therapy during pregnancy. The mean hematocrit was 33.1 ± 1.9% before pregnancy and was well maintained during gestation (33.9 ± 3.8% at the first trimester, 29.2 ± 4.2% at the second trimester, and 33.6 ± 8.7% at delivery). The mean gestation period was 32.7 ± 4.7 weeks, with 60% of patients experiencing premature delivery. The primary maternal complication was pre-eclampsia; 3 women developed pre-eclampsia and underwent emergency cesarean sections. Most neonatal complications were related to preterm birth. CONCLUSION: Dialysis-related care and general clinical management improved the clinical outcome of pregnancy for patients with advanced CKD.
