Peritoneal Dialysis and Hemodialysis in Pregnancy

Management of women who require dialysis during pregnancy is an unusual and challenging clinical problem for both the nephrologist and the obstetrician. More than 200 pregnancies have been reported in women requiring hemodialysis, and more than 50 pregnancies in women on peritoneal dialysis. Surveys from several countries of pregnancy in dialysis patients provide data regarding management and outcomes. Conception rates are significantly lower in women on dialysis, and when these women do become pregnant, the spontaneous abortion rate usually exceeds 40%. However, in the pregnancies that continue, as many as 71% result in surviving infants. Pregnant women require longer, more intense hemodialysis, and enough experience has been reported to support the use of peritoneal dialysis as well as hemodialysis during pregnancy. The patients typically experience anemia, hypertension, and premature delivery. Most infants are small for gestational age, and the stillbirth rate is as high as 12%. While the potential problems are many, sufficient data has been accumulated to provide clinicians with guidelines to help them manage pregnant women on dialysis and to achieve successful outcomes.