Phosphorus-enriched hemodialysis during pregnancy: Two case reports

Area of Science:

• Nephrology
• Obstetrics
• Maternal-Fetal Medicine

Background:

• Pregnancy in women with established renal disease or end-stage renal disease requiring dialysis is uncommon.
• While conception rates have increased, successful outcomes remain challenging.
• Intensive hemodialysis regimens can lead to hypophosphatemia, posing risks to mother and fetus.

Purpose of the Study:

• To report the multidisciplinary management of two pregnant women with end-stage renal disease who developed hypophosphatemia during intensive hemodialysis.
• To evaluate the efficacy of adding sodium phosphate to dialysate for correcting hypophosphatemia in this population.

Main Methods:

• Case report of two pregnant patients with end-stage renal disease undergoing intensive hemodialysis.
• Monitoring of serum inorganic phosphorus levels.
• Intervention: addition of sodium phosphate salts to the dialysate.

Main Results:

• Both patients developed hypophosphatemia after intensive hemodialysis.
• Supplementation with sodium phosphate salts effectively corrected serum inorganic phosphorus levels.
• One patient delivered a healthy infant at 28 weeks gestation; the other had a nonviable delivery at 25 weeks.

Conclusions:

• Multidisciplinary management and dialysate phosphate supplementation can be effective in treating hypophosphatemia during pregnancy in women with end-stage renal disease.
• This approach may improve pregnancy outcomes, although challenges remain.
• Further research is needed to optimize dialysis protocols for pregnant women with kidney failure.