Management of the pregnant chronic dialysis patient

Although unusual, pregnancy in chronic dialysis patients does occur. In fact, the percent of successful pregnancies in women on chronic dialysis may be increasing. But unfortunately, the rates for premature delivery, neonatal death, maternal hypertension, and preeclampsia in the chronic pregnant dialysis patient are high. Consequently, to have a successful outcome for the pregnant dialysis patient, close collaboration between the patient, her nephrologists, high-risk obstetrician, neonatalogist, dialysis nurse, and nutritionist is required. This article reviews and discusses the need for meticulous attention to anemia management, blood pressure control, fluid status, hemodialysis, and peritoneal dialysis prescription, nutrition, and fetal monitoring in the pregnant chronic dialysis patient.