Dr. Jasjit Singh

Dr. Jasjit Singh (JS), Renal Fellow from Icahn School of Medicine at Mount Sinai/EHC, discusses his abstract for the National Kidney Foundation’s 2014 Spring Clinical Meetings (SCM14), Intra-Dialysis Fetal Monitoring in 2 Case Series of Pregnant Hemodialysis (HD) Patients, with Dr. Kenar Jhaveri (eAJKD), eAJKD Editor.

eAJKD: Why don’t you tell us a little about your research and abstract being presented at NKF 2014 Spring Meetings?

JS: Pregnancy in the context of end stage renal disease (ESRD) occurs infrequently. Pregnancy remains a challenge in ESRD and requires a multi-disciplinary team approach. Current recommendations for pregnant dialysis patients have included increasing dialysis to 5 to 7 sessions per week (>20 hours/week) to provide optimal control of uremia and better fetal outcomes.

A little is known regarding fetal well being with dialysis. Currently there are no published guidelines on how to assess unborn fetus during hemodialysis.  Goal of this case series was to assess how fluid shifts during hemodialysis effects fetal hemodynamics. We did intra-dialysis fetal monitoring to assess fetal response to hemodialysis.

eAJKD: CKD Stage 5 patients who get pregnant, would you recommend starting dialysis with 20 hours per week HD or monitor and start only when uremic during pregnancy? 

JS: In one of our cases, patient presented with CKD stage 5 without uremic symptoms but had elevated BUN >50. Patient was started on hemodialysis for 6 days/week (>20 hours/week). Dry weight was adjusted weekly to obtain physiological pregnancy weight gain and good blood pressure control was achieved. Pre- hemodialysis BUN was maintained at <50 and recorded no hypotensive episodes while receiving dialysis treatments. Progress of pregnancy was closely monitored with monthly ultrasonography to evaluate fetal growth, gestational age, heart rate (HR) and amniotic fluid index.

Patient had an uneventful pregnancy until late 3rd trimester when she developed oligohydramnios with biophysical profile of 6/8 at 35.5 weeks. Patient was admitted to hospital and C-section was performed without any complications. The infant was observed in the NICU and went home 8 days later.

Based on our case series, I would recommend starting CKD stage 5 patients on hemodialysis if their BUN > 50.

eAJKD: Where do you and your group go from here?

JS: Intra-dialysis fetal monitoring may be a good way to monitor fetal hemodynamics in pregnant dialysis patients. This case series was limited by the small number of patients. Long term studies with more number of patients would help to better understand the usefulness of intra-dialysis fetal monitoring.

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