Pregnancy in chronic renal failure patients treated by hemodialysis: two case reports and a clinical review of management guidelines

Although unusual, pregnancy in chronic dialysis patients does occur. In fact, the percent of successful pregnancies in women on chronic dialysis may be increasing. But unfortunately, the rates for premature delivery, neonatal death, maternal hypertension, and preeclampsia in chronic pregnant dialysis patients are high. Only 50% of pregnancies result in a surviving infant and over 80% of live born infants are premature, often severely premature. The key to improving the outcome of pregnancy in dialysis patients lies in decreasing premature labor and premature rupture of membranes in the late second and early third trimester. In this article, the incidence, duration, fetal and maternal complications, and outcomes of pregnancy in women on chronic dialysis are reviewed. The management of anemia, hypertension, electrolytes, bone minerals, and acid–base parameters in this group of patients is also summarized. We review the prevalence of pregnancy and the fetal outcome in patients with end stage renal disease (ESRD) maintained on hemodialysis previously reported in the literature. Then we report two cases of chronic renal failure patients who conceived while they were on maintenance hemodialysis with successful fetal outcome. In addition to reassessing the previously reported reviews and case reports published in the literature, we propose management guidelines for this group of patients. We emphasize that the intensive interdisciplinary cooperation of nephrologists and obstetricians is imperative for the successful management of pregnancy under these conditions. We advise that all aspects of dialysis, including duration, adequacy, nutrition, anemia, calcium and phosphate metabolism and BP control need to be closely followed throughout the course of pregnancy.