Pregnancy In Women Undergoing Hemodialysis: Case Series In A Southeast Brazilian Reference Center [gestação Em Mulheres Em Tratamento Hemodialítico: Série De Casos Em Um Centro De Referência Do Sudeste Do Brasil]

PURPOSE: To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side. METHODS: Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high- risk prenatal care in Southeast Brazil. RESULTS: Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7. CONCLUSIONS: To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women.37159Bramham, K., Lightstone, L., Pre-pregnancy counseling for women with chronic kidney disease (2012) J Nephrol, 25 (4), pp. 450-459Hou, S., Pregnancy in chronic renal insufficiency and end-stage renal disease (1999) Am J Kidney Dis, 33 (2), pp. 235-252Shemin, D., Dialysis in pregnant women with chronic kidney disease (2003) Semin Dial, 16 (5), pp. 379-383Pipili, C., Grapsa, E., Koutsobasili, A., Sorvinou, P., Poirazlar, E., Kiosses, D., Pregnancy in dialysis-dependent women--the importance of frequent dialysis and collaborative care: A case report (2011) Hemodial Int, 15 (3), pp. 306-311Podymow, T., August, P., Akbari, A., Management of renal disease in pregnancy (2010) Obstet Gynecol Clin North Am, 37 (2), pp. 195-210Siviero, P., Machado, C.J., Cherchiglia, M.L., Chronic kidney failure by means of multiple causes of death in Brazil (2014) Cad Saúde Coletiva, 22 (1), pp. 75-85Furaz-Czerpak, K.R., Fernández-Juárez, G., Moreno-De La Higuera, M.A., Corchete-Prats, E., Puente-García, A., Martín-Hernández, R., Pregnancy in women on chronic dialysis: A review (2012) Nefrologia, 32 (3), pp. 287-294Hou, S.H., Pregnancy in women on haemodialysis and peritoneal dialysis (1994) Baillieres Clin Obstet Gynaecol, 8 (2), pp. 481-500Chao, A.S., Huang, J.Y., Lien, R., Kung, F.T., Chen, P.J., Hsieh, P.C., Pregnancy in women who undergo long-term hemodialysis (2002) Am J Obstet Gynecol, 187 (1), pp. 152-156Reddy, S.S., Holley, J.L., Management of the pregnant chronic dialysis patient (2007) Adv Chronic Kidney Dis, 14 (2), pp. 146-155Piccoli, G.B., Cabiddu, G., Daidone, G., Guzzo, G., Maxia, S., Ciniglio, I., The children of dialysis: Live-born babies from on-dialysis mothers in Italy--an epidemiological perspective comparing dialysis, kidney transplantation and the overall population (2014) Nephrol Dial Transplant, 29 (8), pp. 1578-1586Shahir, A.K., Briggs, N., Katsoulis, J., Levidiotis, V., An observational outcomes study from 1966-2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry (2013) Nephrology (Carlton), 18 (4), pp. 276-284Silva, G.B., Jr., Monteiro, F.A., Mota, R.M., Paiva, J.G., Correia, J.W., Bezerra Filho, J.G., Acute kidney injury requiring dialysis in obstetric patients: A series of 55 cases in Brazil (2009) Arch Gynecol Obstet, 279 (2), pp. 131-137Castellano, G., Losappio, V., Gesualdo, L., Update on pregnancy in chronic kidney disease (2011) Kidney Blood Press Res, 34 (4), pp. 253-260Hladunewich, M., Hercz, A.E., Keunen, J., Chan, C., Pierratos, A., Pregnancy in end stage renal disease (2011) Semin Dial, 24 (6), pp. 634-639Espinoza, F., Romeo, R., Ursu, M., Tapia, A., Vukusich, A., Pregnancy during dialysis: Experience in six patients (2013) Rev Med Chil, 141 (8), pp. 1003-1009Hladunewich, M.A., Hou, S., Odutayo, A., Cornelis, T., Pierratos, A., Goldstein, M., Intensive hemodialysis associates with improved pregnancy outcomes: A Canadian and United States cohort comparison (2014) J am Soc Nephrol, 25 (5), pp. 1103-110