More Dialysis Patients Becoming Pregnant

Dr. Mala Sachdeva MD North Shore University Hospital, Long Island Jewish Medical Center Assistant Professor, Nephrology, Internal Medicine Hofstra North Shore-LIJ School of Interview with:
Dr. Mala Sachdeva MD
North Shore University Hospital, Long Island Jewish Medical Center
Assistant Professor, Nephrology, Internal Medicine
Hofstra North Shore-LIJ School of Medicine

Medical Research: What is the background for this study?

Dr. Sachdeva: The last study examining pregnancy and dialysis outcomes in the United States was performed more than 15 years ago. Our study was conducted to evaluate practice patterns and to trend maternal and fetal outcomes in the pregnant dialysis female over the past five years. We did a surveymonkey-based survey of American nephrologists on their knowledge of managing pregnancy patients on dialysis.

Medical Research: What are the main findings?

Dr. Sachdeva: Over the past five years, more than 59 pregnancies have been reported. During this time period, almost half of the American nephrologist respondents (43%) have cared for pregnant females on hemodialysis. Hence, we can see that more nephrologists are now faced with taking care of the pregnant dialysis patient. Although a good number of patients initiated dialysis during pregnancy (32%), the majority (58%) of pregnancies occurred within the first five years of being on maintenance dialysis.

Pregnancy outcomes can improve. Of the reported pregnancies 23% did not result in live births. 50% of the pregnancies were complicated by preeclampsia. There were no maternal deaths.

Most nephrologists prescribe 4 to 4.5 hours of hemodialysis. 64% of respondents provide dialysis for six days per week. Only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50mg/dL.  75% of respondents do not have access to fetal monitoring during dialysis for their pregnant patient.

There are approximately 32% of American nephrologists who are somewhat to very uncomfortable caring for a pregnant woman on hemodialysis. 51% of American nephrologists or a member of their staff counsel their female dialysis patients about contraception.

So in summary, while majority of the US based nephrologists are trying to dialyze pregnant ESRD patients with more intense prescriptions, there are still some gaps with comfort and knowledge.

Medical Research: What should clinicians and patients take away from your report?

Dr. Sachdeva: We hope to raise awareness regarding the importance of knowing how to dialyze a pregnant female and would like to stress the importance of having good outcomes when dialyzing a pregnant woman. The close interaction between the nephrologist and the obstetrician is a very important one when managing these patients.

Formal guidelines outlining the care of the pregnant woman on dialysis need to be established. These can hopefully improve future outcomes.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Sachdeva: Despite the small response, we will be continuing this survey and we hope to get more responses to this survey so that we can all try to learn from U.S. experience with the goal being to improve maternal and fetal outcomes in our pregnant dialysis patient.


upcoming NKF abstract Spring 2015 Meeting
PREGNANCY OUTCOMES IN HEMODIALYSIS PATIENTS: A NATIONAL SURVEY Interview with: Dr. Mala Sachdeva MD (2015). More Dialysis Patients Becoming Pregnant 

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