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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2003  |  Volume : 14  |  Issue : 4  |  Page : 530-531
Pregnancy in Chronic Hemodialysis Women: Outcome of Multicentric Study

Department of Nephrology, CHU Hédi Chaker, 3025 Sfax, Tunisia

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How to cite this article:
Bahloul H, Kammoun K, Kharrat M, Jarraya F, Charffedine K, Hamida M B, Hachicha J. Pregnancy in Chronic Hemodialysis Women: Outcome of Multicentric Study. Saudi J Kidney Dis Transpl 2003;14:530-1

How to cite this URL:
Bahloul H, Kammoun K, Kharrat M, Jarraya F, Charffedine K, Hamida M B, Hachicha J. Pregnancy in Chronic Hemodialysis Women: Outcome of Multicentric Study. Saudi J Kidney Dis Transpl [serial online] 2003 [cited 2021 Apr 14];14:530-1. Available from: https://www.sjkdt.org/text.asp?2003/14/4/530/32990
To the Editor:

Pregnancy is an infrequent event in women on hemodialysis (HD) [1] and it is exceptional to have a viable baby. [2],[3],[4] Our objectives in this study are to assess the frequency of pregnancy in women on HD and the complications that may occur in both the mother and the fetus.

A questionnaire was sent to fifteen dialysis units in the south of Tunisia. In the event of occurrence of pregnancy in a dialysis patient, the following data were asked for: etiology of renal disease, duration on dialysis, residual renal function, blood pressure control and final outcome of the pregnancies.

All the units responded to the questionnaire. These units together cared for 695 dialysis patients. There were 297 female patients among them of whom 94 were in the child­bearing age (18 to 44 years); 14% of these patients were using contraceptive methods.

During the period between January 1990 and December 1996, 12 pregnancies were reported in 11 women. The median age of the pregnant women was 35 years. All these patients were anuric and six had hypertension. They were all severely anemic, with a mean hemoglobin of 75 g/l. The mean pre-dialysis blood urea nitrogen (BUN) was less than 19 mmol/l in only two patients while the mean residual renal function was 7.3 ml/min [Table - 1].

A total of seven of these pregnancies (58%) ended with having spontaneous abortion, four had premature delivery and only one had full term delivery. Hypertrophied placenta was observed in three of the four (75%) babies born prematurely. Hydramnios occurred in one of the five infants (20%) born alive.

The reported incidence of pregnancy during two years was one percent by Hadi et al and Schimdt et al, [5],[6] while it was reported to be 1.5% by Hou [7],[1] and 2% in by Okundaye. [8]

In our study, the incidence was 5%, which is higher than what has been observed in the other studies. Three factors might explain this difference; firstly the birth rate is relatively high in our population; second, the number in our sample is small and thirdly, contraceptive methods were rarely uesd by our study group.

A successful pregnancy necessitates some precautions such as intensified dialysis; [2],[3],[9],[8],[4] good control of blood pressure; [10],[4] corre­ction of anemia to have hemoglobin at least 75 g/l by blood transfusion or use of erythropoietin. [2],[10],[11]

We conclude from our study that the inci­dence of pregnancy is 5% in HD patients in Tunisia and is associated with considerable morbidity and fetal mortality. [8] Use of contraceptive methods by women on hemodialysis, at risk for pregnancy, is recommended.

   Acknowledgments Top

We thank the doctors who contributed to this project: Chaabouni MN, Chakroun F, Mezghani M, Bouaziz F, Chabchoub M, Chaabouni A, Ayed M, Bourguiba M, Farah S, Salman M, Chaniour S, Arbaoui MS, Miladi M, Ammar M, Chaker J. Bahloul H, Kammoun K, Kharrat M, Jarraya F, Charffedine K, Ben Hamida M, Hachicha J.

   References Top

1.Maruyama H, Shimada H, Obayashi H, et al. Requiring higher doses of erythropoietin suggests pregnancy in hemodialysis patients. Nephron 1998;79:413-9.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Bagon JA, Vernaeve H, de Muylder X, Lafontaine JJ, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis 1998;31:756-65.  Back to cited text no. 2  [PUBMED]  
3.Chan WS, Okun N, Kjellstrand CM. Pregnancy in chronic dialysis: a review and analysis of the literature. Int J Artif Organ 1998;21:259-68.  Back to cited text no. 3    
4.Romao JE Jr, Luders C, Kahhale S, et al. Pregnancy in women on chronic dialysis. A single center experience with 17 cases. Nephron 1998;78(4):416-22.  Back to cited text no. 4    
5.Hadi AM. Pregnancy in renal transplant recipients. A review. J Obstet Gynecol 1984; 35:251-6.  Back to cited text no. 5    
6.Schmidt RJ, Holley JL. Fertility and contraception in end-stage renal disease. Adv Ren Replace Ther 1998;1:38-44.  Back to cited text no. 6    
7.Hou S. Incidence and outcome of pregnancy in end-stage renal disease. J Am Soc Nephrol 1992;3:162-9.  Back to cited text no. 7    
8.Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patient. Am J Kidney Dis 1998;31:766-73.  Back to cited text no. 8  [PUBMED]  
9.Nakai Y, Nishio J, Nishimura S, et al. Umbilical arterial flow change during hemodialysis. J Perinat Med 1998;26:54-5.  Back to cited text no. 9  [PUBMED]  
10.Hou S, Firanek C. Management of the pregnant dialysis patient. Adv Ren Replace Ther 1998;5:24-30.  Back to cited text no. 10  [PUBMED]  
11.Holley JL, Schmidt RJ, Bender FH, Dumler F, Schiff M. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis 1997;29:685-90.  Back to cited text no. 11  [PUBMED]  

Correspondence Address:
J Hachicha
Department of Nephrology, CHU Hédi Chaker, 3025 Sfax
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PMID: 17657128

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