Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes
Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes
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DOI：
10.1093/ndt/gfv395
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发表时间：
2016-11-01
影响因子：
6.1
通讯作者：
Todros, Tullia
中科院分区：
文献类型：
--
作者：
Piccoli, Giorgina Barbara;Minelli, Fosca;Todros, Tullia
在接受透析的妇女的妊娠管理方面取得了进展;然而，单中心研究和少量病例迄今为止还无法明确定义透析时间表与妊娠结局之间的关系。本系统性综述的目的是分析新千年长期透析妊娠患者透析时间表与妊娠结局之间的关系，检索Medline-PubMed、Embase和科克伦图书馆（2000年1月1日至2014年12月31日：MESH、Emtree、妊娠和透析自由术语）。对病例系列（超过5例病例）和病例报告进行了单独分析。在处理较大的血液透析（HD）患者子集的病例系列中进行荟萃回归;病例报告被单独分析[根据腹膜透析（PD）与HD;透析前或透析期间的概念]。我们从2048篇参考文献中获得了190篇全文和25篇会议摘要。我们选择了101篇全文和25篇摘要（36个系列; 90例病例报告），共647例患者的681例妊娠。在病例系列（543例患者中的574例妊娠）中，早产非常频繁（83%）。荟萃回归分析显示HD患者每周透析时间与早产之间存在相关性，对于早产（<37孕周：P = 0.044; r（2）= 0.22）和小于胎龄儿（SGA）（P = 0.017; r（2）= 0.54）具有显著性。SGA与每周透析次数密切相关（P = 0.003; r（2）= 0.84）。病例报告分析表明，HD组SGA的发生率低于PD组（31 vs 66.7%; P = 0.015）。在检索到的文献中没有发现先天性畸形风险增加的证据。关于透析妊娠的数据是异质的，但迅速积累; HD结局的主要决定因素是透析时间表。PD和HD之间的差异应进一步分析。
Advances have been made in the management of pregnancies in women receiving dialysis; however, single-centre studies and small numbers of cases have so far precluded a clear definition of the relationship between dialysis schedules and pregnancy outcomes. The aim of the present systematic review was to analyse the relationship between dialysis schedule and pregnancy outcomes in pregnancies in chronic dialysis in the new millennium.Medline-PubMed, Embase and the Cochrane library were searched (1 January 2000-31 December 2014: MESH, Emtree, free terms on pregnancy and dialysis). A separate analysis was performed for case series (more than five cases) and case reports. Meta-regression was performed in case series dealing with the larger subset of haemodialysis (HD) patients; case reports were analysed separately [according to peritoneal dialysis (PD) versus HD; conception before or during dialysis].We obtained 190 full texts and 25 congress abstracts from 2048 references. We selected 101 full papers and 25 abstracts (36 series; 90 case reports), for a total of 681 pregnancies in 647 patients. In the case series (574 pregnancies in 543 patients), preterm delivery was extremely frequent (83%). Meta-regression analysis showed a relationship between hours of dialysis per week in HD and preterm delivery, and was significant for preterm deliveries (< 37 gestational weeks: P = 0.044; r(2) = 0.22) and for small for gestational age (SGA) (P = 0.017; r(2) = 0.54). SGA was closely associated with the number of dialysis sessions per week (P = 0.003; r(2) = 0.84). Case report analysis suggests a lower incidence of SGA on HD versus PD (31 versus 66.7%; P = 0.015). No evidence of an increased risk of congenital abnormality was found in the retrieved papers.Data on pregnancy on dialysis are heterogeneous but rapidly accumulating; the main determinant of outcomes on HD is the dialysis schedule. The differences between PD and HD should be further analysed.