Duffner Johannes, Schulte-Kemna Lena, Reister Barbara, Ludwig Ulla, Keller Frieder, van Erp Rene, Schröppel Bernd
Clin Nephrol. 2017 Nov;88(11):264-269. doi: 10.5414/CN109032.
To assess the experience and practice patterns of nephrologists in Germany with regard to the care of pregnant women on dialysis.
The 26-item internet survey sent by email asked for demographic information, subjective proficiency, maternal and fetal complications, treatment approaches and goals.
Of the 2,015 surveys sent out, 200 (10%) were available for evaluation. 38% of respondents never provided care, whereas 62% treated at least one pregnant patient on dialysis. In 306 total reported cases of pregnant women on dialysis, 58% became pregnant while on maintenance dialysis, and 42% developed dialysis-dependent renal failure in the course of pregnancy. For women on peritoneal dialysis (PD), only 22% of the nephrologists would continue PD until delivery, while 78% would convert to hemodialysis either immediately or shortly before delivery. 40% of the respondents reported complications in either mother or child. 45% of the respondents routinely provided prenatal counseling, and 2/3 of the nephrologists did not routinely perform fetal monitoring. While we found a significant difference in self-reported proficiency between nephrologists having and those not having treated pregnant women on dialysis, only 40% of all physicians felt confident in treating pregnant women on dialysis.
CONCLUSIONS: Our survey demonstrates that the practice of nephrologists in treating pregnant women on dialysis differs significantly. These findings highlight the need for European guidelines to standardize the care of pregnant dialysis patients. .
评估德国肾病学家在护理透析孕妇方面的经验和实践模式。
通过电子邮件发送的包含26个项目的网络调查问卷询问了人口统计学信息、主观熟练程度、母婴并发症、治疗方法和目标。
在发出的2015份调查问卷中，有200份（10%）可供评估。38%的受访者从未提供过护理，而62%的受访者至少治疗过一名透析孕妇。在总共报告的306例透析孕妇病例中，58%在维持性透析期间怀孕，42%在妊娠期间发展为依赖透析的肾衰竭。对于接受腹膜透析（PD）的女性，只有22%的肾病学家会持续进行腹膜透析直至分娩，而78%会在分娩前立即或不久后转为血液透析。40%的受访者报告了母亲或孩子出现并发症。45%的受访者常规提供产前咨询，并且三分之二的肾病学家不常规进行胎儿监测。虽然我们发现治疗过透析孕妇的肾病学家与未治疗过的肾病学家在自我报告的熟练程度上存在显著差异，但所有医生中只有40%对治疗透析孕妇有信心。
我们的调查表明，肾病学家在治疗透析孕妇方面的实践存在显著差异。这些发现凸显了制定欧洲指南以规范透析孕妇护理的必要性。
