Moscoso-Solorzano Grace Tamara, Farfan Jimenez Andrea Gabriela
Clin Nephrol. 2019 Dec;92(6):319-324. doi: 10.5414/CN109130.
Pregnancy is uncommon in women with chronic kidney disease (CKD), even more so in end-stage renal diseases (ESRD), and it is associated with high risks and complications that could lead to fetal and maternal morbidity or mortality and adverse outcomes.
This was a descriptive observational study with 14 pregnant women with CKD. Comparison of clinical and biochemical variables between CKD-5D and non-dialysis dependent CKD patients was performed.Categorical variables were summarized as frequencies and percentages. For continuous variables, mean and standard deviation were reported. The significance of differences between groups was assessed by Student's t-test, and p-value ≤ 0.05 was considered statistically significant.
57% of patients (n = 8/14) were on chronic hemodialysis (HD). Mean time on dialysis was 11 ± 4 months. All HD patients were on intensified therapy (24 hours weekly) since 12 weeks of pregnancy. The presence of severe hypertension, valvular heart disease, diastolic dysfunction, activity of systemic lupus erythematosus, and abortions were more frequent in the HD-CKD group. Patients with CKD but no HD had decreased renal function. The mean gestational age at delivery and birth weight in the HD-CKD group was lower than in the non-HD-CKD group but without statistically significant differences. There were no neonatal or maternal deaths in either group.
Pregnancy in women with ESRD is complicated by increased adverse maternal and fetal outcomes, these remain high in women with kidney disease notwithstanding advances in obstetric and neonatal care. A HD condition seems to be related to worse outcomes. Preconception counseling and tight control after conception, including multidisciplinary evaluation and individualized therapy should be done.
慢性肾脏病（CKD）女性怀孕并不常见，终末期肾病（ESRD）女性更是如此，且怀孕与高风险及并发症相关，可能导致胎儿和母亲发病、死亡及不良后果。
这是一项针对14名CKD孕妇的描述性观察性研究。对CKD-5D患者和非透析依赖型CKD患者的临床及生化变量进行了比较。分类变量以频率和百分比进行汇总。对于连续变量，报告了均值和标准差。通过学生t检验评估组间差异的显著性，p值≤0.05被认为具有统计学意义。
57%的患者（n = 8/14）接受慢性血液透析（HD）。平均透析时间为11±4个月。所有HD患者自怀孕12周起接受强化治疗（每周24小时）。HD-CKD组中重度高血压、瓣膜性心脏病、舒张功能障碍、系统性红斑狼疮活动及流产更为常见。患有CKD但未接受HD治疗的患者肾功能下降。HD-CKD组的平均分娩孕周和出生体重低于非HD-CKD组，但无统计学显著差异。两组均无新生儿或母亲死亡。
ESRD女性怀孕会因母婴不良结局增加而变得复杂，尽管产科和新生儿护理有所进步，但肾病女性的这些不良结局仍然很高。HD状态似乎与更差的结局相关。应进行孕前咨询并在怀孕后严格控制，包括多学科评估和个体化治疗。
