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Article

Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country

by
Juan Carlos H Hernández Rivera
1,*,
María Juana Pérez López
2,
Carlos Humberto Corzo Bermúdez
2,
Luis García Covarrubias
3,
Luis Antonio Bermúdez Aceves
4,
Conrado Alejandro Chucuan Castillo
2,
Mariana Salazar Mendoza
5,
Giorgina Barbara Piccoli
6,7,*,† and
Ramón Paniagua Sierra
1,†
1
Unidad de Investigación Médica en Enfermedades Nefrológicas, CMN Siglo XXI, CdMx 06720, Mexico
2
Nephrology Service, Hospital de Especialidades CMN “La Raza”, CdMx 02990, Mexico
3
Transplant Service, Hospital General de Mexico, CdMx 06720, Mexico
4
Transplant Service Hospital de Especialidades CMN “Siglo XXI”, CdMx 06720, Mexico
5
Emergency Service, Hospital Regional “Lic. Adolfo López Mateos”, ISSSTE, CdMx 01030, México
6
Centre Hospitalier Le Mans, 72000 Le Mans, France
7
Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy
*
Authors to whom correspondence should be addressed.
†
Those authors equally contributed to the paper.
J. Clin. Med. 2019, 8(4), 475; https://doi.org/10.3390/jcm8040475
Submission received: 12 February 2019 / Revised: 21 March 2019 / Accepted: 3 April 2019 / Published: 8 April 2019
(This article belongs to the Special Issue Kidney Diseases and Kidney Involvement in Pregnancy: the Crossroad of Obstetrics, Nephrology, Urology and Internal Medicine)
Review Reports Versions Notes

Abstract

Background: 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 h 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.
Keywords: hemodialysis; pregnancy; chronic kidney disease; pregnancy complications hemodialysis; pregnancy; chronic kidney disease; pregnancy complications

Share and Cite

MDPI and ACS Style

Hernández Rivera, J.C.H.; Pérez López, M.J.; Corzo Bermúdez, C.H.; García Covarrubias, L.; Bermúdez Aceves, L.A.; Chucuan Castillo, C.A.; Salazar Mendoza, M.; Piccoli, G.B.; Paniagua Sierra, R. 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. https://doi.org/10.3390/jcm8040475

AMA Style

Hernández Rivera JCH, Pérez López MJ, Corzo Bermúdez CH, García Covarrubias L, Bermúdez Aceves LA, Chucuan Castillo CA, Salazar Mendoza M, Piccoli GB, Paniagua Sierra R. 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. https://doi.org/10.3390/jcm8040475

Chicago/Turabian Style

Hernández Rivera, Juan Carlos H, María Juana Pérez López, Carlos Humberto Corzo Bermúdez, Luis García Covarrubias, Luis Antonio Bermúdez Aceves, Conrado Alejandro Chucuan Castillo, Mariana Salazar Mendoza, Giorgina Barbara Piccoli, and Ramón Paniagua Sierra. 2019. "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 8, no. 4: 475. https://doi.org/10.3390/jcm8040475

APA Style

Hernández Rivera, J. C. H., Pérez López, M. J., Corzo Bermúdez, C. H., García Covarrubias, L., Bermúdez Aceves, L. A., Chucuan Castillo, C. A., Salazar Mendoza, M., Piccoli, G. B., & Paniagua Sierra, R. (2019). 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, 8(4), 475. https://doi.org/10.3390/jcm8040475

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