Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy
Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy
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DOI：
10.1007/s40620-015-0191-3
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发表时间：
2015-06-01
影响因子：
3.4
通讯作者：
Piccoli, Giorgina Barbara
中科院分区：
文献类型：
--
作者：
Cabiddu, Gianfranca;Castellino, Santina;Piccoli, Giorgina Barbara
背景：透析期间怀孕的报道越来越多，这在肾脏病学界也是一个有争议的问题。鉴于这一问题的文化敏感性，文献中提供的病例数量很少，这使得以证据为基础的咨询变得困难。因此，需要立场声明来突出最新的技术水平，并提出未解决的问题以供一般性讨论。方法对文献(MESH、Emtree和关于妊娠和透析的自由术语)进行系统分析，并审查专家意见(肾脏与妊娠研究小组；意大利2000-2013年参与妊娠透析管理的专家)。所涉及的问题：妊娠期开始透析的时间；治疗方式，即腹膜透析(PD)和血液透析(HD)；治疗时间表(两种模式)；产科监测；主要支持疗法(贫血、钙磷甲状旁腺激素；酸中毒)；咨询提示。主要结果开始透析的时间尚不清楚，考虑到不同的支持疗法；PD和HD都有可能成功怀孕；高效率和与残余肾功能的严格结合在两种治疗中都是关键，在这两种治疗中，血尿素氮测试可能是一个有用的标记。到目前为止，长时间工作的高清效果最好。有必要进行严格的个性化产科监测；治疗的目的应该是避免维生素B-12、叶酸和铁缺乏，并纠正贫血；维生素D和钙的使用是安全的，建议使用。应该提醒接受透析的妇女，两种类型的透析治疗都有可能怀孕，尽管很少见，而且成功率可能达到75%以上。需要高的透析效率和频繁的控制以优化结果。
Background Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion.Methods A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000-2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips.Main results Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B-12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75 % may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.