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KMID : 1102220160350020084
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Kidney Research and Clinical Practice
2016 Volume.35 No. 2 p.84 ~ p.89
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The successful clinical outcomes of pregnant women with advanced chronic kidney disease
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Chang Ji-Yeun
Jang Han-Beol
Chung Byung-Ha
Youn Young-Ah
Sung In-Kyung
Kim Yong-Soo
Yang Chul-Woo
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Abstract
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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.
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KEYWORD
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Chronic kidney disease, Dialysis, Pregnancy
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