Mobina Hosein Fakhrabadi,1,*Iman Masoumi,2Rounak Shahoyi,3
1. Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran. 2. Student Research Committee, North Khorasan University of Medical Sciences, Bojnourd, Iran 3. Department of Midwifery, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Introduction: Although pregnancy in women on hemodialysis is not common (incidence rate:1-7%), but in recent decades due to medical advances, the fertility rate of these people has increased. The most important fertility problems in women on dialysis are chronic anovulation, infertility, sexual dysfunction, abortion, and stillbirth. If the pregnancy continues, women on dialysis face serious problems. The present study was conducted with the aim of determining the effect of hemodialysis on pregnancy.
Methods: In this study, Persian and English articles published in SID, Google Scholar, Pubmed, Springer, Scopus and Science Direct databases using the keywords dialysis in pregnancy; end stage renal disease; hemodialysis; peritoneal dialysis; Intensive dialysis regimen was reviewed without restrictions on publication date and 20 articles were selected according to the inclusion criteria.
Results: Even if recently acquired knowledge has improved the outcomes of pregnancies with dialysis, these pregnancies are still a great challenge and require multidisciplinary collaboration. A woman may already be on dialysis, either in case of acute kidney injury that appears for the first time during pregnancy, or if existing renal pathology worsens during pregnancy and becomes necessary (often during the third trimester). Providing intensive hemodialysis is a common treatment approach when dialyzing pregnant women. Maternal and fetal outcomes can be improved. The objective is to maintain a satisfactory clinical status and maternal blood, urea, nitrogen (BUN) levels ≤80 mg / dl and creatinine 5-7 mg / dl for opportune fetal development and birth. Routine pharmacological treatment should continuously be individually adjusted as to the number of medications and dosage. The most important complications that may occur in such pregnancies include miscarriage, stillbirth, preterm labor, preeclampsia, hypertension, intrauterine growth restriction, low birth weight, and congenital anomalies.
Conclusion: Intensive hemodialysis might improve fertility along with maternal and fetal outcomes, but requires careful follow up and management from a multidisciplinary team that includes nephrology professionals working closely with professionals from obstetrics. The strategy choice must consider treatment availability, costs, and maternal/social aspects until future studies provide more reliable evidence.
Keywords: dialysis in pregnancy; end stage renal disease; hemodialysis; peritoneal dialysis