Frequency and Outcomes of Pregnancy on Nocturnal Home Haemodialysis

OBJECTIVE: Pregnancy in women of reproductive age on dialysis is rare and has a poor outcome. Several studies published in the 1990s revealed pregnancy rates of 0.3 to 0.5 per 100 patient-years, but not all pregnancies resulted in live births. More recent studies suggest that intensive haemodialysis increases fertility and successful pregnancies with live births. Our objectives were to evaluate whether nocturnal home haemodialysis (NHHD) three times a week supports successful pregnancies and live births in addition to the changes in clinical and biochemical parameters. MATERIAL and METHODS: Descriptive cohort study analysing pregnancies and their outcomes in 60 women of reproductive age (14-44 years) who started NHHD between August 2010 and January 2015. RESULTS: During a mean follow-up of 20±11 months on NHHD, four pregnancies were identified (4 per 100 patient-years). In these four patients, the mean age was 37.3±4.8 years and the mean NHHD duration 19±12 months at the beginning of pregnancy. Duration of the weekly haemodialysis session was increased from 23.8±1.8 at baseline to 36.6±0.5 hours at term; serum urea was maintained below 50 mg/dl, and haemoglobin over 10 g/dl with an increase in erythropoietin doses. Blood pressure was within the normal ranges and there was no need for antihypertensive drugs. Three women underwent a caesarean section at 38,35,38 weeks, delivering three healthy newborns without any maternal or fetal complications. Birth weights were 2.750, 2.550 and 3.100 g, respectively. The fourth patient (with a history of secondary amyloidosis and multiple spontaneous abortions) delivered at the 25th week, resulting in neonatal death on the second day. CONCLUSION: We observed that women of reproductive age on NHHD had high rates of conception and live birth.