Dr Razan Zein Isma1,2, Dr GREGORY WILSON1,2
1Department of Nephrology, Mater Hospital Brisbane, South Brisbane, Australia, 2The University of Queensland, Brisbane, Australia
Background
Women with chronic kidney disease (CKD) are at increased risk of complications during pregnancy including requiring dialysis. Current guideline recommended intensive dialysis up to 6 times per week, aiming for a pre-dialysis urea of <12.5mmol/L and initiating dialysis early when serum urea is >15mmol/L for best maternal and fetal outcomes.
Case report
We conducted a retrospective single centered case series of 5 patients with CKD who required dialysis during pregnancy from 2017 to 2021. Three out of five patients had CKD secondary to diabetic nephropathy, one had reflux nephropathy, and one had congenital nephrotic syndrome. One patient was already on peritoneal dialysis at time of conception and transferred to hemodialysis at 13 weeks of gestational age while all other patients were incident hemodialysis patients who commenced once their urea level exceeded 15mmol/L.
Four of the five patients had successful pregnancy while one suffered neonatal death on the first day of life from chorioamnionitis. The youngest live birth was at 25 weeks and the oldest was at 35 weeks of gestational age. Two out of five patients in this study required 30 hours per week of dialysis and dialysis frequency increased with increasing gestational age for all patients. All patients achieved a pre-dialysis urea level of less than 12mmol/L throughout their pregnancy. Only one patient was not dialysis dependent following pregnancy with an eGFR of 15ml/min/1.73m2.
Conclusions
This study highlights the importance of frequent dialysis targeting a urea below 12.5 mmol/L to achieve successful pregnancies in women with advanced CKD. It also demonstrates how pregnancy in women with advanced CKD accelerates the commencement of maintenance dialysis.
Biography:
Dr Razan Zein is a second year physician trainee in Southside Network of Brisbane. Razan is an aspiring nephrologist and also has a keen interest in research and teaching.