Standardization required for the initiation of dialysis during pregnancy

The initiation of dialysis in women with chronic kidney disease during pregnancy varies with clinical practice and indicates the need for standardized care in this population.

Jennifer H. Yo, Monash Health, MBBS, MPH, Melbourne, Australia, and colleagues examined dialysis initiation patterns during pregnancy in a multinational retrospective cohort study of women giving birth between January 1, 2000 and October 31, 2022. Eligible women estimated estimated pregnancy estimated glomerular filtration rate (EGFR) <30 mL/min/1.73 m2 or serum creatinine ≥150 μmol/L within 12 months of conception when first measured during pregnancy.

Overall, 46.7% of women began dialysis during pregnancy at a median pregnancy of 21.4 weeks. Regional differences were observed between the beginning of dialysis and dose (hours per week). Researchers found that women who started dialysis during pregnancy were more likely to have more harmful maternal and fetal outcomes than women who didn't start dialysis during pregnancy. There was no significant association between dialysis time per week and adverse fetal outcomes. The mean change in EGFR at 1 year after delivery and one year before pregnancy was -8.4 mL/min/1.73 m2 for non-dialysis women.

“Our findings provide many necessary modern data on dialysis initiation during pregnancy and maternal and fetal outcomes within a cohort of women with advanced CKD,” the authors write. “The differences between clinicians and localities in practice highlight the need for standardized care to optimize outcomes. Intensifying clinical education in pregnancy counseling is essential, particularly in promoting active discussions about reproductive intentions and contraceptive needs.”

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