Rivera Juan Carlos Hernández, Pérez López María Juana, Corzo Bermúdez Carlos Humberto, García Covarrubias Luis, Bermúdez Aceves Luis Antonio, Chucuan Castillo Conrado Alejandro, Mendoza Mariana Salazar, Piccoli Giorgina Barbara, Sierra Ramón Paniagua
Unidad de Investigación Médica en Enfermedades Nefrológicas, CMN Siglo XXI, 06720 CdMx, México.
Nephrology Service, Hospital de Especialidades CMN "La Raza", 02990 CdMx, México.
J Clin Med. 2019 Apr 8;8(4):475. doi: 10.3390/jcm8040475.
Chronic kidney disease (CKD) is associated with reduction of fertility and increased complications during pregnancy. The aim of this work is to analyze the clinical outcomes and risk factors in pregnant women who needed to start dialysis with different schedules in a public hospital in Mexico City, with particular attention on the interference of social and cultural elements as well as resource limitations.
CKD women who needed dialysis in pregnancy over the period 2002⁻2014 and had with complete demographic and outcome data were included in this retrospective study. Clinical background, renal function during pregnancy, dialysis schedule, and clinical outcomes were reviewed.
Forty pregnancies in women with CKD who needed dialysis in pregnancy (39 singleton and one twin pregnancy) were studied: All patients were treated with hemodialysis. Thirty-nine patients had CKD stages 4 or 5 at referral; only one patient was of stage 3b. Dialysis was considered as indicated in the presence of fluid overload, unresponsive hypertension in the setting of advanced CKD, or when blood urea nitrogen values were increased to around 50 mg/dL. However, the initiation of dialysis was often delayed by days or weeks. The main reason for delaying the initiation of dialysis was patient (and family) refusal to start treatment. All patients were treated with thrice weekly dialysis, in 3⁻5 hour sessions, with a target urea of <100 mg/dL. The number of hours on dialysis did not impact pregnancy outcomes. Ten pregnancies ended in miscarriages (8 spontaneous), 29 in pre-term delivery, and 1 in term delivery. Fifteen women were diagnosed with preeclampsia, one with eclampsia, and one with HELLP (hemolysis, elevated liver enzymes, low platelets,) syndrome. Twenty-four of the neonates survived (77.4% of live births); six singletons and one twin died as a consequence of prematurity. Two neonates displayed malformations: cleft palate with ear anomalies and duodenal atresia.
CKD requiring hemodialysis in pregnancy is associated with a high frequency of complications; in the setting of delayed start and of thrice-weekly hemodialysis, dialysis schedules do not appear to influence outcomes.
慢性肾脏病（CKD）与生育力下降及孕期并发症增加有关。本研究旨在分析墨西哥城一家公立医院中按不同方案开始透析的孕妇的临床结局及危险因素，特别关注社会文化因素及资源限制的影响。
本回顾性研究纳入了2002年至2014年期间孕期需要透析且有完整人口统计学和结局数据的CKD女性。回顾了临床背景、孕期肾功能、透析方案及临床结局。
对孕期需要透析的CKD女性的40次妊娠（39例单胎妊娠和1例双胎妊娠）进行了研究：所有患者均接受血液透析治疗。39例患者转诊时处于CKD 4期或5期；仅1例患者为3b期。当出现液体超负荷、晚期CKD时难治性高血压或血尿素氮值升高至约50mg/dL时，考虑进行透析。然而，透析的启动常常延迟数天或数周。延迟启动透析的主要原因是患者（及家属）拒绝开始治疗。所有患者均接受每周三次透析，每次3至5小时，目标尿素水平<100mg/dL。透析时长并未影响妊娠结局。10次妊娠以流产告终（8例自然流产），29例早产，1例足月分娩。15名女性被诊断为子痫前期，1例子痫，1例伴有溶血、肝酶升高、血小板减少（HELLP）综合征。24例新生儿存活（占活产儿的77.4%）；6例单胎和1例双胎因早产死亡。2例新生儿出现畸形：腭裂伴耳部异常和十二指肠闭锁。
孕期需要血液透析的CKD与高并发症发生率相关；在启动延迟及每周三次血液透析的情况下，透析方案似乎不影响结局。
