Pregnancy during chronic hemodialysis: a single dialysis-unit experience with five cases.

BACKGROUND: Pregnancy is uncommon in women with end-stage renal disease (ESRD) requiring chronic dialysis. An increasing number of successful pregnancies in women in hemodialytic treatment have been recently reported but few institutions experienced more than one or two cases of pregnancy. METHODS: Between 1988-1998 five pregnancies in patients receiving hemodialysis were observed in our center. Medical records of these patients were reviewed. RESULTS: At the conception the mean age was 27 years. One patient started dialysis after conception. All patients received bicarbonate dialysis. Three patients were dialyzed six times per week, the other two patients three-four times per week. The dry weight was increased progressively; on average of 1.2 +/- 0.5 kg in the first trimester and of 0.5 kg per week since the second trimester. The predialysis BUN was maintained between 50-100 mg/dL (17.85-35,70 mmol/L) during the pregnancy. Four patients were treated with erythropoietin to maintain hematocrit between 30-35%. Erythropoietin related-complications were not observed. Polyhydramnios was observed in all cases. All deliveries occurred before term. The mean gestational age of infants was 28.6 +/- 4 weeks. Four out of five pregnancies resulted in liveborn infants. Two infants had an Apgar score of zero. All neonates were of low birth weight (1,431 +/- 738 g) with percentile of birth weight in the normal range. No one was small for date. CONCLUSION: A successful pregnancy is possible in women on chronic dialysis. Prematurity occurs frequently as well as low weight birth leading to increased perinatal morbidity and mortality.