Chronic kidney disease (CKD) and end stage kidney disease are prevalent even in women of reproductive age. These are known to reduce fertility and successful pregnancy. There are chances of conception even in advanced CKD, though laden with complications. We present two cases of women who conceived in advanced CKD and were on haemodialysis in a tertiary hospital in Kenya, and review of literature.
GravesJW.Diagnosis and management of chronic kidney disease. Mayo Clin Proc2008;
83: 1064–1069.
2.
WilliamsDDavisonJ.Chronic kidney disease in pregnancy. BMJ2008;
336: 211–215.
3.
HouS.Historical perspective of pregnancy in chronic kidney disease. Adv Chronic Kidney Dis2007;
14: 116–118.
4.
PiccoliGBAttiniRVasarioE, et al.
Pregnancy and chronic kidney disease: a challenge in all CKD stagesClin J Am Soc Nephrol2010;
5: 844–855.
5.
ChopraSSuriVAggarwalN, et al.
Pregnancy in chronic renal insufficiency: Single centre experience from North India. Arch Gynecol Obstet2009;
279: 691–695.
6.
ImbasciatiEGregoriniGCabidduG, et al.
Pregnancy in CKD stages 3 to 5: and maternal outcomes. Am J Kidney Dis2007;
49: 753–762.
7.
ConfortiniPGalantiGAnconaG, et al.
Full-term pregnancy and successful delivery in a patient on chronichaemodialysis. Proc Eur Dial Transplant Assoc1971;
8: 74–80.
8.
HladunewichMHerczAEKeunenJ, et al.
Pregnancy in end stage renal disease. Semin Dial2011;
24: 634–639.
9.
Successful pregnancies in women treated by dialysis and kidney transplantation.
Report from the Registration Committee of the European Dialysis and Transplant Association. Br J Obstet Gynaecol1980;
87: 839–845.
10.
BagonJAVernaeveHMuylderXD, et al.
Pregnancy and dialysis. Am J Kidney Dis1998;
31: 756–765.
11.
BaruaMHladunewichMKeunenJ, et al.
Successful pregnancies on nocturnal home hemodialysis. CJASN2008;
3: 392–396.
12.
RomãoJrJELudersCKahhaleS, et al.
Pregnancy in women on chronic dialysis. Nephron1998;
78: 416–422.
13.
WilesKSNelson-PiercyCBramhamK.Reproductive health and pregnancy in women with chronic kidney disease. Nat Rev Nephrol2018;
14: 165–184.
14.
McSharryC.Early ckd increases the risk of adverse outcomes in pregnancy. Nat Rev Nephrol2010;
6: 385
15.
WeiYWangYYaoQ, et al.
Successful management of twin pregnancy in a woman with advanced chronic kidney disease: a case report. Medicine (Baltimore)2019;
98: e16840
HeYLiuJCaiQ, et al.
The pregnancy outcomes in patients with stage 3–4 chronic kidney disease and the effects of pregnancy in the long-term kidney function. J Nephrol2018 2018/12/;
31: 953–960. 01
18.
NevisIFReitsmaADominicA, et al.
Pregnancy outcomes in women with chronic kidney disease: a systematic review. Clin J Am Soc Nephrol2011;
6: 2587–2598.
19.
WilesKChappellLClarkK, et al.
Clinical practice guideline on pregnancy and renal disease. BMC Nephrol2019;
20: 1–43. DOI: org/10.1186/s12882-019-1560-2.
20.
FitzpatrickAMohammadiFJesudasonS.Managing pregnancy in chronic kidney disease: improving outcomes for mother and baby. Int J Womens Health2016;
8: 273–285.
21.
HladunewichMSchatellDHladunewichMSchatellD.Intensive dialysis and pregnancy. Hemodial Int2016;
20: 339–348.
22.
HladunewichMAHouSOdutayoA, et al.
Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol2014;
25: 1103–1109.
23.
PiccoliGBCabidduG.Pregnancy and kidney disease:from medicine based on exceptions to exceptional medicine. J Nephrol2017;
30: 303–305.
24.
OkundayeIAbrinkoPHouS.Registry of pregnancy in dialysis patients. Am J Kidney Dis1998;
31: 766–773.
25.
AsamiyaYOtsuboSMatsudaY, et al.
The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int2009;
75: 217–222.
PiccoliGBCabidduGDaidoneG, et al.
The children of dialysis: live-born babies from on-dialysis mothers in Italy—an epidemiological perspective comparing dialysis, kidney transplantation and the overall population. Nephrol Dial Transplant2014;
29: 1578–1586.
28.
RossLESwiftPANewboldSM, et al.
An alternative approach to delivering intensive dialysis in pregnancy. Perit Dial Int2016;
36: 575–577.
29.
JesudasonSGraceBSMcDonaldSP.Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD. CJASN2014;
9: 143–149.
30.
ShawJKatopodisCHladunewichMA, et al.
Changing Dialysis Modality during Pregnancy: A Case Report. Perit Dial Int. 2018;
38: 456–458.
31.
TuranOMTuranSGungorS, et al.
Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol2008;
32: 160–167.
32.
PiccoliGBConijnAConsiglioV, et al.
Pregnancy in dialysis patients: is the evidence strong enough to lead us to change our counselling policy. Clin J Am Soc Nephrol2010;
5: 62–71.
33.
TangrenJNadelMHladunewichMA.Pregnancy and end-stage renal disease. Blood Purif2018;
45: 194–200.
34.
ShehabNLewisCLStreetmanDD, et al.
Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med2009;
10: 256–259.
35.
WilesKChappellLClarkK, et al.
Clinical practice guideline on pregnancy and renal disease. BMC Nephrol2019 2019/;
20: 401. 10/31
36.
BurgnerAHladunewichMA.Women’s reproductive health for the nephrologist. Am J Kidney Dis2019. DOI: 10.1053/j.ajkd.2019.04.017.
