End-Stage Kidney Disease and Dialysis in Pregnancy.
End-Stage Kidney Disease and Dialysis in Pregnancy.
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DOI：
10.1053/j.ackd.2020.06.001
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发表时间：
2020-11
影响因子：
2.9
通讯作者：
Hladunewich MA
中科院分区：
文献类型：
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作者：
Oliverio AL;Hladunewich MA
终末期肾病 (ESKD) 与低生育率有关，接受透析的女性的受孕率估计为总人口的 1/100。然而，接受血液透析的女性的活产率随着时间的推移而增加，而接受腹膜透析的女性的活产率仍然较低且保持不变。对于无残余肾功能的女性，强化血液透析（目标是血清 BUN <35 mg/dL 或每周透析 36 小时）与提高活产率和延长孕龄相关。即使在强化透析队列中，早产率和新生儿重症监护需求也很高，高达 50% 以上。虽然与血液透析妇女相比，怀孕期间接受腹膜透析的妇女早产的风险似乎并未增加，但她们的婴儿更有可能小于胎龄。因此，血液透析已成为妊娠期首选的透析方式。需要提供专门的肾脏病学、产科和新生儿护理来处理这些复杂的妊娠，并且应向所有患有 ESKD 的妇女提供计划生育咨询。
End stage kidney disease (ESKD) is associated with low fertility with rates of conception estimated to occur in women on dialysis at 1/100th of the general population. However, live birth rates are increasing over time in women on hemodialysis, while they remain lower and static in women on peritoneal dialysis. Intensification of hemodialysis, targeting a serum BUN <35 mg/dL or 36 hours of dialysis per week in women with no residual kidney function, is associated with improved live birth rates and longer gestational age. Even in intensively dialyzed cohorts, rates of prematurity and need for neonatal intensive care are high, upwards of 50%. While women on peritoneal dialysis in pregnancy do not appear to be at increased risk of delivering preterm compared to those on hemodialysis, their infants are more likely to be small for gestational age. As such, hemodialysis has emerged as the preferred dialysis modality in pregnancy. Provision of specialized nephrology, obstetric, and neonatal care is necessary to manage these complex pregnancies and family planning counseling should be offered to all women with ESKD.
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