Pregnancy in women on home dialysis: Your questions answered

Women with kidney failure have impaired fertility challenges due to disruption of the hypothalamic gonadal axis and hormonal dysregulation, with pregnancy rates on home dialysis being much lower than those with normal kidney function. Pregnant women on dialysis are at high risk of hypertensive disorders, preterm birth, and fetal growth restriction, but intensified dialysis can mitigate these risks. Home dialysis offers advantages like flexibility, better hemodynamic stability, and improved fetal outcomes, but logistical and training challenges remain. Hybrid approaches combining hemodialysis and peritoneal dialysis may benefit select women during pregnancy. Effective management of pregnancy on dialysis requires treatment of anemia, optimized nutrition, close obstetric monitoring, and multi-disciplinary care. Postpartum care should focus on breastfeeding support, home dialysis prescription adjustment, and contraception counseling. Systematic capacity-building in home dialysis can lead to better pregnancy outcomes while alleviating in-center dialysis burdens.