Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country
AbstractBackground: Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in Mexico City, with particular attention on the interference of social and cultural elements as well as resource limitations. Material and methods: CKD women who needed dialysis in pregnancy over the period 2002–2014 and had with complete demographic and outcome data were included in this retrospective study. Clinical background, renal function during pregnancy, dialysis schedule, and clinical outcomes were reviewed. Results: Forty pregnancies in women with CKD who needed dialysis in pregnancy (39 singleton and one twin pregnancy) were studied: All patients were treated with hemodialysis. Thirty-nine patients had CKD stages 4 or 5 at referral; only one patient was of stage 3b. Dialysis was considered as indicated in the presence of fluid overload, unresponsive hypertension in the setting of advanced CKD, or when blood urea nitrogen values were increased to around 50 mg/dL. However, the initiation of dialysis was often delayed by days or weeks. The main reason for delaying the initiation of dialysis was patient (and family) refusal to start treatment. All patients were treated with thrice weekly dialysis, in 3–5 hour sessions, with a target urea of <100 mg/dL. The number of hours on dialysis did not impact pregnancy outcomes. Ten pregnancies ended in miscarriages (8 spontaneous), 29 in pre-term delivery, and 1 in term delivery. Fifteen women were diagnosed with preeclampsia, one with eclampsia, and one with HELLP (hemolysis, elevated liver enzymes, low platelets,) syndrome. Twenty-four of the neonates survived (77.4% of live births); six singletons and one twin died as a consequence of prematurity. Two neonates displayed malformations: cleft palate with ear anomalies and duodenal atresia. Conclusions: CKD requiring hemodialysis in pregnancy is associated with a high frequency of complications; in the setting of delayed start and of thrice-weekly hemodialysis, dialysis schedules do not appear to influence outcomes.
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Rivera, J.C.H.; Pérez López, M.J.; Corzo Bermúdez, C.H.; García Covarrubias, L.; Bermúdez Aceves, L.A.; Chucuan Castillo, C.A.; Mendoza, M.S.; Piccoli, G.B.; Sierra, R.P. Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country. J. Clin. Med. 2019, 8, 475.
Rivera JCH, Pérez López MJ, Corzo Bermúdez CH, García Covarrubias L, Bermúdez Aceves LA, Chucuan Castillo CA, Mendoza MS, Piccoli GB, Sierra RP. Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country. Journal of Clinical Medicine. 2019; 8(4):475.Chicago/Turabian Style
Rivera, Juan Carlos Hernández; Pérez López, María Juana ; Corzo Bermúdez, Carlos Humberto; García Covarrubias, Luis ; Bermúdez Aceves, Luis Antonio ; Chucuan Castillo, Conrado Alejandro ; Mendoza, Mariana Salazar; Piccoli, Giorgina Barbara; Sierra, Ramón Paniagua. 2019. "Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country." J. Clin. Med. 8, no. 4: 475.
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