Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Kidney Res Clin Pract. 2016 Jun;35(2):84-9. doi: 10.1016/j.krcp.2015.12.005. Epub 2016 Feb 17.
Successful pregnancy outcomes in patients with advanced chronic kidney disease (CKD) are increasingly common in Western countries. However, in Korea, the available literature addressing this clinical issue is scarce.
We reviewed 5 successful parturitions [1 patient with Stage 5 CKD and 4 with maintenance hemodialysis (HD)] at Seoul St. Mary's Hospital over 3 years and investigated changes in dialysis prescription, anemia management, and the incidence of maternal and neonatal complications.
There were no maternal or neonatal deaths in this cohort. The mean age at the time of conception and delivery was 35.8 ± 3.7 and 36.2 ± 3.5 years, respectively. Dialysis patients received more frequent and intensified HD during pregnancy, 20.0 ± 5.7 h/wk of HD over 5 visits with the ultrafiltration dose maintained between 1 and 2 kg per session. All patients received erythropoietin-stimulating agents and iron replacement therapy during pregnancy. The mean hematocrit was 33.1 ± 1.9% before pregnancy and was well maintained during gestation (33.9 ± 3.8% at the first trimester, 29.2 ± 4.2% at the second trimester, and 33.6 ± 8.7% at delivery). The mean gestation period was 32.7 ± 4.7 weeks, with 60% of patients experiencing premature delivery. The primary maternal complication was pre-eclampsia; 3 women developed pre-eclampsia and underwent emergency cesarean sections. Most neonatal complications were related to preterm birth.
Dialysis-related care and general clinical management improved the clinical outcome of pregnancy for patients with advanced CKD.
在西方国家，患有晚期慢性肾脏病（CKD）的患者成功妊娠的情况越来越常见。然而，在韩国，针对这一临床问题的可用文献很少。
我们回顾了首尔圣玛丽医院 3 年来 5 例成功分娩的病例（1 例 5 期 CKD 患者和 4 例维持性血液透析（HD）患者），并调查了透析方案、贫血管理以及母婴并发症的发生率变化。
该队列中无孕产妇或新生儿死亡。受孕和分娩时的平均年龄分别为 35.8±3.7 岁和 36.2±3.5 岁。透析患者在怀孕期间接受了更频繁和强化的 HD，每次透析超滤量为 1 至 2 公斤，每周 20.0±5.7 小时，共 5 次透析。所有患者在怀孕期间均接受了促红细胞生成素刺激剂和铁替代治疗。受孕前平均血细胞比容为 33.1±1.9%，在妊娠期间得到很好的维持（孕早期 33.9±3.8%，孕中期 29.2±4.2%，孕晚期 33.6±8.7%）。平均孕龄为 32.7±4.7 周，60%的患者早产。主要的母体并发症是子痫前期；3 名妇女出现子痫前期并接受了紧急剖宫产。大多数新生儿并发症与早产有关。
透析相关护理和一般临床管理改善了晚期 CKD 患者妊娠的临床结局。
