Dr. Mala Sachdeva, from Hofstra North Shore-LIJ School of Medicine, Great Neck, NY, discusses her abstract for the National Kidney Foundation’s 2015 Spring Clinical Meetings (SCM15), Pregnancy Outcomes in Hemodialysis Patients: A National Survey, with Dr. Kenar Jhaveri, AJKD Blog Editor. (Note: Drs. Sachdeva and Jhaveri are at the same institution.)
AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2015 Spring Meetings?
MS: The last study examining pregnancy and dialysis outcomes in the United States was performed more than 15 years ago. Our study was conducted to evaluate practice patterns and to trend maternal and fetal outcomes in the pregnant dialysis female over the past five years. We did a surveymonkey-based survey of American nephrologists on their knowledge of managing pregnancy patients on dialysis.
Over the past five years, more than 59 pregnancies have been reported. During this time period, almost half of the American nephrologist respondents (43%) have cared for pregnant females on hemodialysis. Hence, we can see that more nephrologists are now faced with taking care of the pregnant dialysis patient. Although a good number of patients initiated dialysis during pregnancy (32%), the majority (58%) of pregnancies occurred within the first five years of being on maintenance dialysis. Pregnancy outcomes can improve. Of the reported pregnancies 23% did not result in live births. 50% of the pregnancies were complicated by preeclampsia. There were no maternal deaths. Most nephrologists prescribe 4 to 4.5 hours of hemodialysis. 64% of respondents provide dialysis for six days per week. Only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50mg/dL 75% of respondents do not have access to fetal monitoring during dialysis for their pregnant patient.
There are approximately 32% of American nephrologists who are somewhat to very uncomfortable caring for a pregnant woman on hemodialysis. 51% of American nephrologists or a member of their staff counsel their female dialysis patients about contraception. So in summary, while majority of the US based nephrolgoists are trying to dialyze pregnant ESRD patients with more intense prescriptions, there are still some gaps with comfort and knowledge.
AJKDblog: Even with a small response rate, only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50 mg/dL. Do you think care of the pregnant patient with need for HD requires a referral to an academic center with experience to improve outcomes?
MS: Although the pregnant dialysis patient is now encountered more frequently, there are still approximately one third of American Nephrologists who are uncomfortable taking care of a pregnant woman on hemodialysis. In addition, fetal monitoring should be utilized during the hemodialysis session to make dialysis safer, once the fetus is viable. For these reasons, an academic center may be the most appropriate place to refer this group of patients to.
AJKDblog: Where do you and your group go from here?
MS: We hope to raise awareness regarding the importance of having good outcomes when dialyzing a pregnant woman. Perhaps fellowship programs can incorporate the teaching of how to dialyze a pregnant patient into their curriculums.
In addition, formal guidelines outlining the care of the pregnant woman on dialysis need to be established. These can hopefully improve future outcomes.
We will be continuing this survey and we hope to get more responses to this survey so that we can all try to learn from U.S. experience with the goal being to improve maternal and fetal outcomes in our pregnant dialysis patient.
Click here for a full list of SCM15 abstracts of poster presentations.
Check out more AJKDblog coverage of the NKF’s 2015 Spring Clinical Meetings!