Successful pregnancy in a patient on regular hemodialysis awaiting kidney transplantation

• Main Authors: E. I. Prokopenko, I. G. Nikol'skaya, O. B. Rybakova, S. V. Novikova, E. Yu. Upriamova
• Format: Article
• Language: Russian
• Published: MONIKI 2018-01-01
• Series: Alʹmanah Kliničeskoj Mediciny
• Subjects: pregnancy; renal failure; renal replacement therapy; regular hemodialysis
• Online Access: https://www.almclinmed.ru/jour/article/view/645
• ISSN: 2072-0505; 2587-9294

Currently, the prevalence of chronic kidney disease in the general population is in the range of 8.7 to 18.4%, being at least 3% in women of childbearing age. Therefore, improvement of pregnancy outcomes in patients with chronic kidney disease is an important medical and social problem. In the past, pregnancy in women receiving the program hemodialysis (HD) was considered impossible. The first successful pregnancy in HD was described in 1971. Recently, pregnancy outcomes in dialysis patients significantly improved with an increase in the live births to 73–79%. It was shown that intensification of the dialysis program plays an important role in the achievement of a  favorable pregnancy outcome, with an increase in the number of sessions to 6 weekly, and the total weekly duration of dialysis of up to 24 hours and more. We present a  clinical case of a  favorable course of pregnancy that was eventually detected in a  patient on program HD during her examination before the kidney transplantation. Her dialysis program was intensified, with no subsequent complications characteristic of pregnancy in chronic kidney disease, such as hypertension, preeclampsia, severe anemia, and serious fetal growth retardation syndrome. At week 38 of gestation, programmed vaginal delivery was performed; a healthy girl was born who did not need any intensive care. The successful outcome of this pregnancy was due to intensive dialysis treatment, a multidisciplinary approach to pregnancy management, and thorough obstetric monitoring.