Is successful pregnancy possible in patients on renal replacement therapy?
Fertility is markedly decreased in dialysis patients with frequency of conception ranging from 0.3% to 1.5% per dialysis patient per year. One exception is a 15% conception rate among women treated with nocturnal dialysis. There are no data on whether or not women were trying to become pregnant. Outcomes are better with increased dialysis hours. In women with less than 20 hours of dialysis per week, infant survival is about 50%. Infant survival increases to 75% with 20 or more hours of dialysis. The most encouraging outcomes originate from women receiving nocturnal dialysis (48 h/week) where 84.6% of infants survived. Prematurity is decreased in the pregnancies of nocturnal dialysis patients with a mean gestational age of 36 weeks. Life-threatening hypertension can occur up to 6 weeks postpartum in dialysis patients. There are no data on the ideal time to start dialysis in pregnant women, but fetal loss appears to increase when the serum creatinine is between 3 and 4 mg/dL.
For pregnancies in women with kidney insufficiency severe enough to require starting dialysis during pregnancy, infants survival is around 75%. With lesser degrees of kidney insufficiency, infant survival is above 80%. There are two studies in women with serum creatinine over 2 mg/dL where fetal survival was 100%.
