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FRIAT, Móstoles, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Gestación con éxito en una paciente con insuficiencia renal crónica en programa de hemodiálisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10741_108_15824_en_t2_carta.jpg" "Alto" => 349 "Ancho" => 600 "Tamanyo" => 155686 ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory variables and drug dose during pregnancy" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">Frequency of pregnancies during haemodialysis is low (between 0.3% and 0.75% per year in women of child-bearing age).<span class="elsevierStyleSup">1</span> This fact is due to different hormonal factors which produce amenorrhoea.<span class="elsevierStyleSup">2-4</span></p><p class="elsevierStylePara">Maternal complications include: miscarriage, placenta abruptio, anaemia, infection, premature breakage of membranes, polyhydramnios, preterm labour, arterial hypertension, pre-eclampsia and eclampsia, haemorrhage, need for caesarean section, and maternal death. Foetal complications include: slow foetal growth, acute or chronic foetal distress, premature birth, newborn respiratory problems, increased stay in neonatal intensive care, and stillbirths or neonatal deaths.<span class="elsevierStyleSup">5,6</span></p><p class="elsevierStylePara">We present the case of a 31-year-old patient with chronic renal failure (CRF) secondary to interstitial and tubular kidney disease due to a neurogenic bladder. She started renal replacement therapy with haemodialysis 15 months before.</p><p class="elsevierStylePara">Her medical history included: lipomyelomeningocele, cauda equina syndrome; neurogenic bladder; 3 pregnancies (2 miscarriages and 1 live birth).</p><p class="elsevierStylePara">In April 2010, she reported amenorrhoea for one week, and ultrasound confirmed that she was 10 weeks pregnant. At this time, the patient had a creatinine clearance of 10ml/minute and residual diuresis of 2000ml/day (via self-catheterisation which has been performed since she was 5 years old due to her neurogenic bladder).</p><p class="elsevierStylePara">The following regimen was established:</p><p class="elsevierStylePara">Haemodialysis dosage was increased to six weekly sessions of 180 minutes, which resulted in: improved blood volume control (with no hypertensive or hypotensive events), less restriction on liquid intake solute fluctuation prevention, less episodes of low foetoplacental blood flow, reducing predialysis urea levels, and increasing protein intake.</p><p class="elsevierStylePara">We used a polysulfone dialyser with an ultrafiltration coefficient (<span class="elsevierStyleItalic">K</span>Uf) of 82mL, and porous membrane thickness 40µm.</p><p class="elsevierStylePara">Qb was set at 300-350ml/minute and Qd at 500ml/minute.</p><p class="elsevierStylePara">The maximum ultrafiltration per hour was established at 400ml/hour to prevent hypotension. Weight adjustment was performed in accordance with the patient’s blood pressure and clinical profile.</p><p class="elsevierStylePara">Weekly analytical tests were performed.</p><p class="elsevierStylePara">Drug treatment was: erythropoietin, iron i.v., oral bicarbonate and folic acid. Paracalcitol was withdrawn given the lack of experience with this drug in pregnant patients.</p><p class="elsevierStylePara">We did not observe any alterations in blood sugar levels and the three O’Sullivan’s tests were normal.</p><p class="elsevierStylePara">The adjusted protein catabolism rate was 0.8 (same as before pregnancy) and the average standard Kt/V during the 9 months was 3.16. Weighted growth rate was 9kg.</p><p class="elsevierStylePara">Table 1 shows the remaining analytical parameters: blood pressure, dry weight, and erythropoietin dosage.</p><p class="elsevierStylePara">She did not have any fistula complications. She was not prescribed antihypertensive drugs at any moment.</p><p class="elsevierStylePara">Complications included: acute phlegmonous appendicitis (successfully repaired); haematuria with pathological urine sediments (treated with antibiotics). Haematuria disappeared and sediment normalised; and three urinary infection episodes (treated with antibiotics).</p><p class="elsevierStylePara">The patient was hospitalised at 36 weeks, having a forceps-assisted vaginal delivery. The baby weighed 2.9kg and Apgar score was 9/10.</p><p class="elsevierStylePara">The patient recovered satisfactorily. Residual diuresis and creatinine clearance results after 1 month were similar to pre-pregnancy results: 2000ml/day and 9ml/min, respectively. The other biochemical parameters were normal and she returned to her dialysis regimen of three sessions a week with good tolerance.</p><p class="elsevierStylePara">In 1980, the European Dialysis Transplant Association (EDTA) published a case study on 13 000 women of fertile age. There were 115 conceptions among them: 45 therapeutic abortions, 53 miscarriages, and of the remaining pregnancies, the birth rate was 23% <span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">In 1996, Hou published another case study conducted in 206 North American dialysis units in 1990 and 1991. The sample included 1281 women between 18 and 44 years old. Almost 70% of the pregnancies before 1990 ended in miscarriage, while less than 40% after 1990 ended in abortion or miscarriage.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">There are very few cases described during recent years, and those which we have found have been from some centres’ isolated experience. Most report successful pregnancy rates, above 70%.<span class="elsevierStyleSup">7.8</span></p><p class="elsevierStylePara">In 2005, Haase et al<span class="elsevierStyleSup">9 </span>published the first prospective study on 5 patients treated between 2000 and 2004 at the Charité University Hospital in Berlin with a 100% birth rate  </p><p class="elsevierStylePara">Recently, Luders published a case study in the <span class="elsevierStyleItalic">AMJ</span> of all the pregnancies that occurred between 1988 and 2008 (it is the largest record to date) in women undergoing dialysis in the nephrology department of the San Paulo University Hospital, Brazil. Fifty-two pregnancies were studied, and 86.5% of them were successful.<span class="elsevierStyleSup">10 </span></p><p class="elsevierStylePara">The survival rate of the babies born of mothers undergoing haemodialysis has improved, from 23% in 1980<span class="elsevierStyleSup">11</span><span class="elsevierStyleSup"> </span>to almost 90% during the last decade.<span class="elsevierStyleSup">9,10</span> However, foetal mortality is higher for women undergoing haemodialysis than the general population.<span class="elsevierStyleSup">5-9 </span></p><p class="elsevierStylePara">To date, a systematic nephrological or gynaecological treatment for this type of patient has yet to reported in the medical literature.<span class="elsevierStyleSup">9 </span></p><p class="elsevierStylePara">Various measures are mentioned in publications, such as: increase the erythropoietin dosage , increase dialysis time, use low ultrafiltration rates to improve blood volume control, avoid hypotension events, reduce liquid intake restrictions and maintain low predialysis urea levels.<span class="elsevierStyleSup">9,10,12,13</span></p><p class="elsevierStylePara">Pregnancy during dialysis continues to be rare and it occurs in various units. This makes it a difficult research point,<span class="elsevierStyleSup">14</span> but nevertheless these pregnancies should be included in a register, in the same way that other Societies and the EDTA have done.</p><p class="elsevierStylePara"><a href="grande/10741_108_15824_en_t2_carta.jpg" class="elsevierStyleCrossRefs"><img src="10741_108_15824_en_t2_carta.jpg" alt="Clinical and laboratory variables and drug dose during pregnancy"></img></a></p><p class="elsevierStylePara">Table 1. Clinical and laboratory variables and drug dose during pregnancy</p>" "pdfFichero" => "P1-E518-S2914-A10741-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10741_108_15824_en_t2_carta.jpg" "Alto" => 349 "Ancho" => 600 "Tamanyo" => 155686 ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory variables and drug dose during pregnancy" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "López Menchero R, Albero MD, Cabeza B, Álvarez L, Del Pozo C, Sánchez L. Successfull pregnancy in a patient with systemic lupus erythematosus on hemodialysis. 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Year/Month | Html | Total | |
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2024 November | 7 | 9 | 16 |
2024 October | 61 | 39 | 100 |
2024 September | 55 | 35 | 90 |
2024 August | 76 | 72 | 148 |
2024 July | 60 | 36 | 96 |
2024 June | 69 | 52 | 121 |
2024 May | 88 | 28 | 116 |
2024 April | 72 | 40 | 112 |
2024 March | 60 | 30 | 90 |
2024 February | 53 | 35 | 88 |
2024 January | 65 | 39 | 104 |
2023 December | 51 | 33 | 84 |
2023 November | 69 | 27 | 96 |
2023 October | 63 | 38 | 101 |
2023 September | 82 | 41 | 123 |
2023 August | 70 | 23 | 93 |
2023 July | 75 | 31 | 106 |
2023 June | 69 | 30 | 99 |
2023 May | 60 | 34 | 94 |
2023 April | 50 | 25 | 75 |
2023 March | 38 | 20 | 58 |
2023 February | 41 | 29 | 70 |
2023 January | 60 | 23 | 83 |
2022 December | 54 | 34 | 88 |
2022 November | 51 | 28 | 79 |
2022 October | 115 | 47 | 162 |
2022 September | 77 | 48 | 125 |
2022 August | 55 | 46 | 101 |
2022 July | 56 | 44 | 100 |
2022 June | 44 | 40 | 84 |
2022 May | 60 | 44 | 104 |
2022 April | 43 | 53 | 96 |
2022 March | 56 | 56 | 112 |
2022 February | 56 | 38 | 94 |
2022 January | 63 | 45 | 108 |
2021 December | 56 | 47 | 103 |
2021 November | 71 | 39 | 110 |
2021 October | 61 | 63 | 124 |
2021 September | 71 | 37 | 108 |
2021 August | 80 | 38 | 118 |
2021 July | 66 | 49 | 115 |
2021 June | 60 | 15 | 75 |
2021 May | 75 | 37 | 112 |
2021 April | 171 | 59 | 230 |
2021 March | 174 | 24 | 198 |
2021 February | 81 | 17 | 98 |
2021 January | 40 | 29 | 69 |
2020 December | 65 | 14 | 79 |
2020 November | 59 | 12 | 71 |
2020 October | 36 | 12 | 48 |
2020 September | 49 | 1 | 50 |
2020 August | 63 | 10 | 73 |
2020 July | 55 | 7 | 62 |
2020 June | 78 | 21 | 99 |
2020 May | 71 | 13 | 84 |
2020 April | 64 | 18 | 82 |
2020 March | 92 | 11 | 103 |
2020 February | 66 | 23 | 89 |
2020 January | 92 | 27 | 119 |
2019 December | 79 | 33 | 112 |
2019 November | 110 | 24 | 134 |
2019 October | 57 | 13 | 70 |
2019 September | 102 | 28 | 130 |
2019 August | 71 | 16 | 87 |
2019 July | 101 | 19 | 120 |
2019 June | 57 | 13 | 70 |
2019 May | 64 | 14 | 78 |
2019 April | 94 | 24 | 118 |
2019 March | 57 | 12 | 69 |
2019 February | 35 | 22 | 57 |
2019 January | 42 | 12 | 54 |
2018 December | 73 | 37 | 110 |
2018 November | 108 | 17 | 125 |
2018 October | 108 | 20 | 128 |
2018 September | 71 | 17 | 88 |
2018 August | 44 | 24 | 68 |
2018 July | 45 | 6 | 51 |
2018 June | 41 | 11 | 52 |
2018 May | 48 | 13 | 61 |
2018 April | 33 | 6 | 39 |
2018 March | 44 | 9 | 53 |
2018 February | 32 | 3 | 35 |
2018 January | 52 | 6 | 58 |
2017 December | 38 | 10 | 48 |
2017 November | 45 | 12 | 57 |
2017 October | 42 | 8 | 50 |
2017 September | 53 | 15 | 68 |
2017 August | 69 | 22 | 91 |
2017 July | 55 | 23 | 78 |
2017 June | 45 | 23 | 68 |
2017 May | 51 | 34 | 85 |
2017 April | 36 | 35 | 71 |
2017 March | 17 | 24 | 41 |
2017 February | 26 | 11 | 37 |
2017 January | 32 | 15 | 47 |
2016 December | 62 | 9 | 71 |
2016 November | 66 | 17 | 83 |
2016 October | 89 | 12 | 101 |
2016 September | 122 | 8 | 130 |
2016 August | 171 | 6 | 177 |
2016 July | 190 | 11 | 201 |
2016 June | 113 | 0 | 113 |
2016 May | 138 | 0 | 138 |
2016 April | 112 | 0 | 112 |
2016 March | 91 | 0 | 91 |
2016 February | 81 | 0 | 81 |
2016 January | 101 | 0 | 101 |
2015 December | 110 | 0 | 110 |
2015 November | 70 | 0 | 70 |
2015 October | 79 | 0 | 79 |
2015 September | 58 | 0 | 58 |
2015 August | 66 | 0 | 66 |
2015 July | 59 | 0 | 59 |
2015 June | 42 | 0 | 42 |
2015 May | 52 | 0 | 52 |
2015 April | 5 | 0 | 5 |