Document Detail


Obstetric outcome in pregnant women on long-term dialysis: a case series.
MedLine Citation:
PMID:  20382457     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although still uncommon, pregnancy frequency in women on maintenance hemodialysis therapy has increased in the past 20 years. Most published reports suggest that intensified hemodialysis regimens result in better pregnancy outcomes. The small number of patients investigated in all reported series is the main limitation of the available studies. STUDY DESIGN: Retrospective case series. SETTING & PARTICIPANTS: Data for all pregnancies that occurred in 1988-2008 in women undergoing maintenance hemodialysis (52 pregnancies) at the São Paulo University Medical School (São Paulo, Brazil). OUTCOMES & MEASUREMENTS: We analyzed maternal and fetal outcomes of 52 pregnancies, as well as their relationship with various clinical, laboratory, and hemodialysis parameters, such as pre-eclampsia, pregnancy before or after dialysis therapy, hemodialysis dose, polyhydramnios, anemia, and predialysis serum urea level. In addition, logistic regression models for a composite adverse fetal outcome (perinatal death or extremely premature delivery) and linear regression models for birth weight were built. RESULTS: 87% overall rate of successful delivery, with a mean gestational age of 32.7 +/- 3.1 weeks. Pre-eclampsia was associated with a poor prognosis compared with pregnancies without pre-eclampsia: a successful delivery rate of 60% versus 92.9% (P = 0.02), extremely premature delivery rate of 77.8% versus 3.3% (P < 0.001), lower gestational age (P < 0.001), and birth weight (P < 0.001). Patients with an adverse composite fetal outcome had a higher frequency of pre-eclampsia (P < 0.001), lower frequency of polyhydramnios (P = 0.03), lower third-trimester hematocrit (P = 0.03), and higher predialysis serum urea level (P = 0.03). The same results were seen for birth weight. LIMITATIONS: Retrospective data analysis. The absence of creatinine clearance measurements did not allow evaluation of the impact of residual renal function on fetal outcome. CONCLUSIONS: Outcomes of pregnancy in women undergoing hemodialysis often are good. Pre-eclampsia, third-trimester hematocrit, polyhydramnios, and predialysis serum urea level are important variables associated with fetal outcome and birth weight.
Authors:
Claudio Luders; Manuel Carlos Martins Castro; Silvia Maria Titan; Isac De Castro; Rosilene Mota Elias; Hugo Abensur; João Egidio Romão
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Publication Detail:
Type:  Case Reports; Comparative Study; Journal Article     Date:  2010-04-10
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  56     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-07-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  77-85     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Division of Nephrology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Humans
Infant, Newborn
Kidney Failure, Chronic / blood,  complications,  therapy*
Pre-Eclampsia / blood,  therapy
Pregnancy
Pregnancy Complications / blood,  therapy*
Pregnancy Outcome*
Renal Dialysis / methods*
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
Am J Kidney Dis. 2010 Jul;56(1):5-6   [PMID:  20620681 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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