Pregnancy in Patients on Chronic Ambulatory Peritoneal Dialysis

doi:10.1016/S0272-6386(12)70308-6

American Journal of Kidney Diseases

Volume 20, Issue 4, October 1992, Pages 407-410

https://doi.org/10.1016/S0272-6386(12)70308-6 Get rights and content

Abstract

Both conception and successful completion of pregnancy are rare occurrences in female patients on chronic renal replacement therapy. Only a handful of successful pregnancies and deliveries have been reported in patients receiving hemodialysis (HD). Even less common are reports of successful pregnancy and delivery in patients receiving chronic ambulatory peritoneal dialysis (CAPD). Among the more common causes of fetal loss are abruptio placentae and other causes of spontaneous miscarriage. We report here three cases of pregnancy in patients on CAPD; two of these pregnancies progressed successfully to spontaneous delivery, while the third terminated during an episode of acute peritonitis. Furthermore, we have reviewed the literature concerning the outcome of pregnancy in the dialysis population on CAPD.

References (20)

KR Herwig et al.
Chronic renal disease and pregnancy
Am J Obstet Gynecol
(1965)
AI Katz et al.
Pregnancy in women with kidney disease
Kidney Int
(1980)
S Hou
Pregnancy in women requiring dialysis for renal failure
Am J Kidney Dis
(1987)
GJ Becker et al.
Effect of pregnancy on moderate renal failure in reflux nephropathy
Br Med J
(1986)
P Confortini et al.
Full term pregnancy and successful delivery in a patient on chronic haemodialysis
Proc Eur Dial Transplant Assoc
(1971)
LG Fine et al.
Systemic lupus erythematosus in pregnancy
Ann Intern Med
(1981)
WM Trebbin
Haemodialysis and pregnancy
JAMA
(1979)
FP Brunner et al.
Combined report on regular haemodialysis and transplantation in Europe, XV
Proc Eur Dial Transplant Assoc
(1984)
M Redrow et al.
Dialysis in the management of pregnant patients with renal insufficiency
Medicine (Baltimore)
(1988)
SD Lavoie et al.
Two successful pregnancies on CAPD
Adv CAPD
(1988)

There are more references available in the full text version of this article.

Cited by (39)

Pregnancies in Women With Kidney Failure on Home Dialysis in the United States
2024, Kidney International Reports
Women with kidney failure have impaired fertility and are at a higher risk of maternal and fetal morbidity and mortality. Little is known about pregnancies in women receiving maintenance home dialysis in the United States.
Using data from the United States Renal Data System (USRDS), a cohort of 26,387 women aged 15 to 49 years with kidney failure receiving maintenance home dialysis from 2005 to 2018 was examined. We calculated pregnancy rates and identified factors, including the modality associated with pregnancy receiving home dialysis.
Overall, 437 pregnancies were identified in 26,837 women on home dialysis. The unadjusted pregnancy rate was 8.6 per 1000 person-years (PTPY). The unadjusted pregnancy rate was higher on home hemodialysis (16.0 vs. 7.5 PTPY) than on peritoneal dialysis. Women receiving home hemodialysis had a higher adjusted likelihood of pregnancy than women receiving peritoneal dialysis (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.79–3.05). Compared with women aged 20 to 24 years, the likelihood of pregnancy was lower in women aged 30 to 34 years (HR, 0.64; 95% CI, 0.43–0.96), 35 to 39 years (HR, 0.53; 95% CI, 0.35–0.79), 40 to 44 years (HR, 0.32; 95% CI, 0.21–0.49), and 45 to 49 years (HR, 0.21; 95% CI, 0.13–0.33). Whereas Black women had a higher likelihood of pregnancy (HR, 1.40; 95% CI, 1.07–1.83), there was no difference in likelihood of pregnancy in Asian, Hispanic, and Native Americans as compared to Whites. Body mass index, cause of kidney failure, socioeconomic status, rurality, predialysis nephrology care, or dialysis vintage were not significantly associated with pregnancy on home dialysis.
The pregnancy rate in women with kidney failure undergoing home dialysis is higher with home hemodialysis than with peritoneal dialysis. Younger age and Black race or ethnicity are associated with a higher likelihood of pregnancy among women receiving home dialysis. This information can guide clinicians in preconception counselling and making informed treatment decisions for pregnant women on home dialysis.
Pregnancy in Dialysis Patients
2017, Handbook of Dialysis Therapy: Fifth Edition
Pregnancy in patients on chronic dialysis: A single center experience and combined analysis of reported results
2008, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
Cases with triplet pregnancies and reports with no information on delivery were also excluded. A total of 10 cases series studies of more than 5 cases each [2,4–8,10,12,13,15] and 12 case reports [11,16–26] were identified, resulting in a total of 131 cases in the analysis, including our patients. Cases with elective termination of pregnancy were excluded.
Pregnancy is rare in patients on chronic dialysis, with only a 30–50% rate of successful delivery reported in a previous review article. The pregnancy outcome has improved in recent decades, but data on pregnancy outcome are limited due to the small sample size of previous case series. This study investigated the pregnancy outcome in patients on chronic dialysis over the past 15 years in a single center, and also performed a combined analysis of results of individual cases from previously reported series to obtain overall estimates of rates of successful delivery.
Medical records for a total of 13 pregnancies in 13 women undergoing chronic dialysis (10 on hemodialysis and 3 on peritoneal dialysis) during the period from 1990 to 2006 in our hospital were retrospectively reviewed. Data on the changes in dialysis regimen, medical complications, obstetric conditions, and perinatal problems were collected. An electronic search of PubMed identified 10 case series studies and 12 case reports published after 1990 with adequate individual information available. Pooled data from a total of 131 cases, including our patients (117 hemodialysis and 14 peritoneal dialysis), were analyzed using the χ²-test and the t-test to compare the rate of successful delivery and birth weight in the hemodialysis group and the peritoneal dialysis group, and in pregnancies with conception prior to and those with conception after starting dialysis.
Among the 10 pregnant women who decided to continue their pregnancies in our hospital, 5 delivered live newborns and 5 pregnancies ended with intra-uterine fetal demise or neonatal death. The overall rate of successful delivery was 70.9% (83 out of 117) in patients on hemodialysis and 64.2% (9/14) in patients on peritoneal dialysis. The birth weight for these groups was 1483 ± 116 and 1623 ± 320 g, respectively. The difference in the rates of successful delivery in these two groups was not significant (p = 0.61). However, the birth weight was significantly greater in patients who conceived after than those who conceived prior to starting hemodialysis (1529 ± 132 g versus 1245 ± 200 g; p = 0.04).
This study found that the outcome of pregnancy on chronic dialysis has improved in recent decades, but our study showed no significant difference in the rate of successful delivery between patients on hemodialysis and those on peritoneal dialysis.
Pregnancy in dialysis patients
2008, Handbook of Dialysis Therapy
Obstetric outcomes in women with end-stage renal failure requiring renal dialysis
2006, International Journal of Gynecology and Obstetrics
To study obstetric outcomes in women with end-stage renal failure undergoing chronic renal dialysis. Methods: A retrospective review of the database from the High-Risk Pregnancy Clinic at Singapore General Hospital, Singapore. Results: From 1995 to 2004, 7 women treated with chronic renal dialysis had a total of 11 pregnancies. There were 2 pregnancy losses at previable gestation ages and 9 live births. Median gestational age at delivery was 31 weeks, and mean birth weight was 1390 g. Seven newborns had a low birth weight and 5 required neonatal intensive care. Severe hypertension occurred in 4 women for a total of 7 pregnancies. Other complications included polyhydramnios (n = 2), preterm prelabor rupture of membranes (n = 2), obstetric cholestasis (n = 2), postpartum hemorrhage (n = 1), thrombosis of the arteriovenous fistula (n = 2), postpartum peritonitis (n = 1), and fetal anomaly (n = 1). There were no maternal deaths. Conclusion: Such pregnancies are high-risk, particularly because of maternal hypertension and prematurity. They should be managed by multidisciplinary teams, and prepregnancy counseling should not be neglected.
Pregnancy and delivery in women treated with renal replacement therapy: A literature review
2021, Ukrainian Journal of Nephrology and Dialysis

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Pregnancy in Patients on Chronic Ambulatory Peritoneal Dialysis

Abstract

Am J Obstet Gynecol

Kidney Int

Am J Kidney Dis

Effect of pregnancy on moderate renal failure in reflux nephropathy

Br Med J

Full term pregnancy and successful delivery in a patient on chronic haemodialysis

Proc Eur Dial Transplant Assoc

Systemic lupus erythematosus in pregnancy

Ann Intern Med

Haemodialysis and pregnancy

JAMA

Combined report on regular haemodialysis and transplantation in Europe, XV

Proc Eur Dial Transplant Assoc

Dialysis in the management of pregnant patients with renal insufficiency

Medicine (Baltimore)

Two successful pregnancies on CAPD

Adv CAPD