Washington, DC (February 13, 2014) — Intensive dialysis treatments in pregnant women with kidney failure lead to a higher proportion of live births than standard dialysis care, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings suggest that more frequent and longer dialysis sessions should be considered for dialysis patients of childbearing age who want to become pregnant or who are already pregnant.
When young women develop advanced kidney disease, pregnancy becomes dangerous and often impossible because their fertility declines as their kidney disease progresses. Also, in the few women with kidney failure who conceive while on dialysis, pregnancy is typically complicated and can be dangerous for both the mother and baby.
In Toronto, young kidney failure patients are offered more intensive dialysis to help improve their quality of life. Physicians have found that such intensive dialysis also helps restore fertility and allow some young women to conceive.
Michelle Hladunewich, MD (Sunnybrook Health Sciences Centre, in Toronto) and her colleagues assessed the effects of such intensive dialysis on pregnancy outcomes by comparing patients from Toronto with that from the United States. In Toronto, young women undergo on average 43 hours of dialysis per week compared with only 17 hours per week in the United States. The researchers' analysis included 22 pregnancies in the Toronto Pregnancy and Kidney Disease Clinic and Registry (2000-2013) with 70 pregnancies in the American Registry for Pregnancy in Dialysis Patients (1990-2011). In Toronto, 18 of the pregnancies occurred after the start of dialysis, whereas dialysis was initiated during pregnancy in four women. In America, 57 pregnancies occurred in women already on dialysis and 13 occurred in women approaching the need for dialysis.
Among the major findings:
"More intensive dialysis has improved pregnancy rates and dramatically improved pregnancy outcomes," said Dr. Hladunewich. "This study provides hope to young women on dialysis who might want to consider having a family."
Study co-authors include Susan Hou, MD, Ayodele Odutayo, MD, Tom Cornelis, MD, Andreas Pierratos, MD, Marc Goldstein, MD, Karthik Tennankore, MD, Johannes Keunen, MD, PhD, Dini Hui, MD, and Christopher Chan, MD.
Disclosures: The authors reported no financial disclosures.
The article, entitled "Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison," will appear online at http://jasn.asnjournals.org/ on February 13, 2014.
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