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01-06-2015 | Position paper and Guideline

Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

Authors: Gianfranca Cabiddu, Santina Castellino, Giuseppe Gernone, Domenico Santoro, Franca Giacchino, Olga Credendino, Giuseppe Daidone, Gina Gregorini, Gabriella Moroni, Rossella Attini, Fosca Minelli, Gianfranco Manisco, Tullia Todros, Giorgina Barbara Piccoli, On behalf of Kidney and Pregnancy Study Group of Italian Society of Nephrology

Published in: Journal of Nephrology | Issue 3/2015

Abstract

Background

Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion.

Methods

A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000–2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips.

Main results

Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B₁₂, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75 % may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

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Title: Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy
Authors: Gianfranca Cabiddu
Santina Castellino
Giuseppe Gernone
Domenico Santoro
Franca Giacchino
Olga Credendino
Giuseppe Daidone
Gina Gregorini
Gabriella Moroni
Rossella Attini
Fosca Minelli
Gianfranco Manisco
Tullia Todros
Giorgina Barbara Piccoli
On behalf of Kidney and Pregnancy Study Group of Italian Society of Nephrology
Publication date: 01-06-2015
Publisher: Springer International Publishing
Published in: Journal of Nephrology / Issue 3/2015
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-015-0191-3

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