Article Figures & Data
Figures
- Figure 1.
Live birth rates by dialysis intensity. In women with established ESRD, there is a significant dose-response relationship between hemodialysis intensity and the live birth rate (P=0.02), improving from 48% in women receiving ≤20 hours to 75% in women receiving between 21 and 36 hours to 85% in women receiving ≥37 hours of hemodialysis weekly.
- Figure 2.
Time-to-event analysis by dialysis intensity. In women with established ESRD, there is a significant pregnancy survival advantage among women with high delivered doses of dialysis (log-rank test; P=0.01).
- Figure 3.
Gestational age and birth weight by dialysis intensity. In women with established ESRD, gestational age increased significantly with higher levels of hemodialysis (A) along with a trend toward larger babies (B). The circle represents an outlier. *P=0.002.
Tables
- Table 1.
Patient characteristics, pregnancy outcomes, and complications in the Toronto PreKid Clinic and Registry
Patient Age (yr)a Gravida Para Cause of ESRD Comorbidities GA (wk) Weight (g) Complications 1 39 G2P1 IgAN HTN, DVT (recurrent in pregnancy) 26+1 980 Short cervix, preterm delivery 2 34 G1P0 Medullary cystic disease HTN, parathyroidectomy, PCOS 37+2 2015 Transient polyhydramnios 3 Pregnancy 1 36 G1P0 Liver transplant/CNI toxicity Liver transplant ×2 for sclerosing cholangitis, Burkitt's lymphoma 37+4 2930 None Pregnancy 2 38 G2P1 38+3 2520 None 4 Pregnancy 1 30 G1P0 Liver transplant/CNI toxicity Liver transplant for sclerosing cholangitis 37+0 3175 Short cervix Pregnancy 2 35 G2P1 22+2 460 Preterm delivery, neonatal death 5 34 G1P0 SLE SLE, juvenile scleroderma, HTN, congenital deafness 32+3 1120 Preeclampsia, IUGR 6 33 G2P1 MPGN Failed transplant due to rejection—CMV, EBV infections, cardiac arrest in prior pregnancy 36+1 2415 None 7 Pregnancy 1 30 G1P0 IgAN HTN 38+0 3000 None Pregnancy 2 32 G2P1 37+4 2785 None 8 37 G4P0 Hypoplastic kidneys Failed transplants (×2), HTN (retinal bleed), 3 prior spontaneous abortions (GA 5–8 wk) 38+5 2750 None 9 27 G1P0 Hereditary nephritis Hyperparathyroidism 36+5 2690 None 10 34 G1P0 PCKD HTN, failed transplant with nephrectomy 30+0 1260 Preterm delivery, cause unclear 11 25 G1P0 Hypertensive nephrosclerosis Failed transplant, HTN 32+1 1850 Rescue cerclage (22 wk), chorioamnionitis, PPROM 12 Pregnancy 1 34 G2P1 IgAN Preeclampsia in prior pregnancy, HTN 36+6 2900 None Pregnancy 2 36 G3P2 36+2 3030 None 13 Pregnancy 1 35 G1P0 PAN Failed transplant due to rejection, bronchiectasis due to recurrent pneumonia 35+2 1680 Late-onset IUGR Pregnancy 2 37 37+2 2202 None 14 33 G1P0 IgAN None 37+6 2866 None 15 38 G2P0 IgAN Preeclampsia in prior pregnancy, HTN, pyelonephritis 27+3 360 IUGR, intrauterine fetal demise 16 37 G4P2 Chronic GN NYD Preeclampsia in prior pregnancy, HTN 12+0 NA First-trimester loss, severe hypertension 17 (twin pregnancy) 31 G5P2 Chronic GN NYD HTN in prior pregnancy, sickle cell trait 33+4 2000, 1600 Short cervix, PPROM, preterm delivery GA, gestational age; IgAN, IgA nephropathy; HTN, hypertension; DVT, deep vein thrombosis; PCOS, polycystic ovarian syndrome; CNI, calcineurin inhibitor; IUGR, intrauterine growth restriction; MPGN, membranoproliferative GN; CMV, cytomegalovirus; EBV, Epstein–Barr virus; PCKD, polycystic kidney disease; PPROM, preterm premature rupture of membranes; PAN, polyarteritis nodosa; GN NYD, GN not yet diagnosed; NA, not available.
↵a Age is at conception.
Pregnancy Outcomes Toronto PreKid Cohort United States ARPD Cohort P Value Live birth rate (entire cohort) 19 (86.4) 43 (61.4) 0.03 Spontaneous abortion, first trimester 1 (4.5) 5 (7.1) Spontaneous abortion, second trimester 0 (0) 14 (20.0) Neonatal death 1 (4.5) 5 (7.1) Still birth 1 (4.5) 3 (4.3) Live birth rate (ESRD patients only) 15 (83.3) 30 (52.6) 0.02 Among patients with established ESRD Dialysis time (h/wk) 43±6 17±5 <0.001 Gestational age (wk) 36 (32–37) 27 (21–35) 0.002 Among patients with renal failure during pregnancy Dialysis time (h/wk) 33±6 15±4 <0.001 Gestational age (wk) 34 (29–37) 33 (31–37) NS All pregnancies (except first- and second-trimester spontaneous abortions Dialysis time (h/wk) 42±7 17±5 <0.001 Birth weight (g) 2118±857 1748±949 NS Among surviving infants in established ESRD patients Normal birth weight 8 (50.0) 10 (32.3) NS Low birth weight (<2500 g) 7 (43.8) 12 (38.7) Very low birth weight (<1500 g) 1 (6.3) 9 (29.0) Values are presented as n (%), mean±SD, or median (interquartile range). Values for gestational age are rounded to the nearest week.
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- Managing Kidney Failure with Home Hemodialysis
- Changing Dialysis Modality during Pregnancy: A Case Report
- Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice
- Peritoneal Dialysis in Pregnancy--A Reflection on the Occasion of World Kidney Day
- An Alternative Approach to Delivering Intensive Dialysis in Pregnancy