End stage renal disease (ESRD) is diagnosed when the kidneys no longer function well enough to effectively rid the body of toxins. Survival requires dialysis or transplant. Fertility declines as kidney function declines and many women find it impossible to become pregnant once diagnosed with ESRD. Those who do conceive often experience complications that endanger both mother and baby but a new study offers hope for ESRD patients yearning for motherhood. When dialysis is aggressive, the study finds, these women often experience fewer complications and the rate of live births almost doubles.
The medical system in Canada differs in many ways from the medical system in the United States. Young ESRD patients in Canada, for example, have access to a more intensive level of dialysis with the expectation it will improve quality of life. In some cases, intensive dialysis has been found to restore fertility enough that conception, pregnancy, and childbirth are possible.
Michelle Hladunewich, a doctor with the Toronto Sunnybrook Health Sciences Centre compared dialysis outcomes on pregnant patients in Canada and the US. The Hladunewich team analyzed data from two sources:
Canada — Toronto Pregnancy and Kidney Disease Clinic and Registry
22 pregnancies listed between 2000 and 2013:
- 18 pregnancies occurred after dialysis began
- 4 women were already pregnant when dialysis began
- Young Canadian women typically spend an average of 43 hours on dialysis per week.
US — American Registry for Pregnancy in Dialysis Patients
70 pregnancies listed from 1990 to 2011:
- 57 pregnancies occurred after dialysis started
- 13 women became pregnant as the need for dialysis was becoming apparent
- Young women in the US typically spend an average of 17 hours on dialysis per week.
Of patients who were undergoing dialysis when pregnancy commenced:
- 83% — live births in Canada
- 53% — live births in the US
- 36 weeks — median length of gestation in Canada
- 27 weeks — median length in the US
Live birth rates varied according to the weekly intensity level of dialysis:
- 85% — live births for women getting more than 36 hours of dialysis per week
- 48% — live births when dialysis lasted 20 hours or less per week
Women who had more than 20 hours of dialysis per week gave birth to babies of healthier birth weight than women dialyzed 20 hours or fewer per week. The women receiving intensive dialysis experienced fewer complications of pregnancy and childbirth and the complications were classified as manageable.
Hdladunewich says, “This study provides hope to young women on dialysis who might want to consider having a family.” The study proves pregnancy outcomes can be “dramatically improved” when dialysis is received in sessions that are longer and more frequent than are typically done in the US.
Source: Hladunewich, Michelle A, et al. “Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison.” JASN / Journal of the American Society of Nephrology. The American Society of Nephrology. Feb 13, 2014. Web. Mar 13, 2014.