Cargando…

Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country

Background: Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in M...

Descripción completa

Detalles Bibliográficos
Autores principales: Hernández Rivera, Juan Carlos H, Pérez López, María Juana, Corzo Bermúdez, Carlos Humberto, García Covarrubias, Luis, Bermúdez Aceves, Luis Antonio, Chucuan Castillo, Conrado Alejandro, Salazar Mendoza, Mariana, Piccoli, Giorgina Barbara, Paniagua Sierra, Ramón
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518183/
https://www.ncbi.nlm.nih.gov/pubmed/30965626
http://dx.doi.org/10.3390/jcm8040475
_version_ 1783418407882850304
author Hernández Rivera, Juan Carlos H
Pérez López, María Juana
Corzo Bermúdez, Carlos Humberto
García Covarrubias, Luis
Bermúdez Aceves, Luis Antonio
Chucuan Castillo, Conrado Alejandro
Salazar Mendoza, Mariana
Piccoli, Giorgina Barbara
Paniagua Sierra, Ramón
author_facet Hernández Rivera, Juan Carlos H
Pérez López, María Juana
Corzo Bermúdez, Carlos Humberto
García Covarrubias, Luis
Bermúdez Aceves, Luis Antonio
Chucuan Castillo, Conrado Alejandro
Salazar Mendoza, Mariana
Piccoli, Giorgina Barbara
Paniagua Sierra, Ramón
author_sort Hernández Rivera, Juan Carlos H
collection PubMed
description Background: Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in Mexico City, with particular attention on the interference of social and cultural elements as well as resource limitations. Material and methods: CKD women who needed dialysis in pregnancy over the period 2002–2014 and had with complete demographic and outcome data were included in this retrospective study. Clinical background, renal function during pregnancy, dialysis schedule, and clinical outcomes were reviewed. Results: Forty pregnancies in women with CKD who needed dialysis in pregnancy (39 singleton and one twin pregnancy) were studied: All patients were treated with hemodialysis. Thirty-nine patients had CKD stages 4 or 5 at referral; only one patient was of stage 3b. Dialysis was considered as indicated in the presence of fluid overload, unresponsive hypertension in the setting of advanced CKD, or when blood urea nitrogen values were increased to around 50 mg/dL. However, the initiation of dialysis was often delayed by days or weeks. The main reason for delaying the initiation of dialysis was patient (and family) refusal to start treatment. All patients were treated with thrice weekly dialysis, in 3–5 h sessions, with a target urea of <100 mg/dL. The number of hours on dialysis did not impact pregnancy outcomes. Ten pregnancies ended in miscarriages (8 spontaneous), 29 in pre-term delivery, and 1 in term delivery. Fifteen women were diagnosed with preeclampsia, one with eclampsia, and one with HELLP (hemolysis, elevated liver enzymes, low platelets,) syndrome. Twenty-four of the neonates survived (77.4% of live births); six singletons and one twin died as a consequence of prematurity. Two neonates displayed malformations: cleft palate with ear anomalies and duodenal atresia. Conclusions: CKD requiring hemodialysis in pregnancy is associated with a high frequency of complications; in the setting of delayed start and of thrice-weekly hemodialysis, dialysis schedules do not appear to influence outcomes.
format Online
Article
Text
id pubmed-6518183
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-65181832019-05-31 Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country Hernández Rivera, Juan Carlos H Pérez López, María Juana Corzo Bermúdez, Carlos Humberto García Covarrubias, Luis Bermúdez Aceves, Luis Antonio Chucuan Castillo, Conrado Alejandro Salazar Mendoza, Mariana Piccoli, Giorgina Barbara Paniagua Sierra, Ramón J Clin Med Article Background: Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in Mexico City, with particular attention on the interference of social and cultural elements as well as resource limitations. Material and methods: CKD women who needed dialysis in pregnancy over the period 2002–2014 and had with complete demographic and outcome data were included in this retrospective study. Clinical background, renal function during pregnancy, dialysis schedule, and clinical outcomes were reviewed. Results: Forty pregnancies in women with CKD who needed dialysis in pregnancy (39 singleton and one twin pregnancy) were studied: All patients were treated with hemodialysis. Thirty-nine patients had CKD stages 4 or 5 at referral; only one patient was of stage 3b. Dialysis was considered as indicated in the presence of fluid overload, unresponsive hypertension in the setting of advanced CKD, or when blood urea nitrogen values were increased to around 50 mg/dL. However, the initiation of dialysis was often delayed by days or weeks. The main reason for delaying the initiation of dialysis was patient (and family) refusal to start treatment. All patients were treated with thrice weekly dialysis, in 3–5 h sessions, with a target urea of <100 mg/dL. The number of hours on dialysis did not impact pregnancy outcomes. Ten pregnancies ended in miscarriages (8 spontaneous), 29 in pre-term delivery, and 1 in term delivery. Fifteen women were diagnosed with preeclampsia, one with eclampsia, and one with HELLP (hemolysis, elevated liver enzymes, low platelets,) syndrome. Twenty-four of the neonates survived (77.4% of live births); six singletons and one twin died as a consequence of prematurity. Two neonates displayed malformations: cleft palate with ear anomalies and duodenal atresia. Conclusions: CKD requiring hemodialysis in pregnancy is associated with a high frequency of complications; in the setting of delayed start and of thrice-weekly hemodialysis, dialysis schedules do not appear to influence outcomes. MDPI 2019-04-08 /pmc/articles/PMC6518183/ /pubmed/30965626 http://dx.doi.org/10.3390/jcm8040475 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hernández Rivera, Juan Carlos H
Pérez López, María Juana
Corzo Bermúdez, Carlos Humberto
García Covarrubias, Luis
Bermúdez Aceves, Luis Antonio
Chucuan Castillo, Conrado Alejandro
Salazar Mendoza, Mariana
Piccoli, Giorgina Barbara
Paniagua Sierra, Ramón
Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country
title Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country
title_full Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country
title_fullStr Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country
title_full_unstemmed Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country
title_short Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country
title_sort delayed initiation of hemodialysis in pregnant women with chronic kidney disease: logistical problems impact clinical outcomes. an experience from an emerging country
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518183/
https://www.ncbi.nlm.nih.gov/pubmed/30965626
http://dx.doi.org/10.3390/jcm8040475
work_keys_str_mv AT hernandezriverajuancarlosh delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry
AT perezlopezmariajuana delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry
AT corzobermudezcarloshumberto delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry
AT garciacovarrubiasluis delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry
AT bermudezacevesluisantonio delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry
AT chucuancastilloconradoalejandro delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry
AT salazarmendozamariana delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry
AT piccoligiorginabarbara delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry
AT paniaguasierraramon delayedinitiationofhemodialysisinpregnantwomenwithchronickidneydiseaselogisticalproblemsimpactclinicaloutcomesanexperiencefromanemergingcountry