The frequency of pregnancies in women on dialysis is extremely low, although the percentage of successful pregnancies has increased over the years, being, according to different series, higher than 70%. These pregnancies are not without complications for both the mother and the fetus, the management of which requires the joint work of the nephrologist in Delhi, the gynecologist, the nurse and the nutritionist.
Increased dialysis time is known to prolong gestation, resulting in children with higher birth weight, improved life chances, and decreased long-term complications.
The total dialysis time that should be administered weekly varies in the different studies, but, regardless of the criteria that are followed, the prescription of hemodialysis must be sufficient to maintain stable maternal conditions in relation to blood volume, blood pressure and blood pressure gain, weight between sessions.
Nocturnal hemodialysis would have the following advantages: it would allow greater clearance of small and medium molecular weight molecules, and it would improve the control of metabolic, electrolytic, phosphorous, volemia, and blood pressure profiles.
Experience with peritoneal dialysis in pregnant women is limited to a very small number of patients; in fact, the incidence of pregnancy in these patients is lower than those on hemodialysis. This could be due to the presence of hypertonic solutions in the peritoneum, to previous episodes of peritonitis or to physical factors that would interfere with fetal implantation. Most authors recommend not to change the dialysis modality after conception.
The measures referred to in the different publications to achieve successful pregnancies in these patients include: the multidisciplinary approach, increasing dialysis time, keeping pre-dialysis urea levels low, trying to prevent prematurity, strictly controlling blood pressure and electrolytes, preventing urinary infections and adequate fetal monitoring.