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Abstract: TH-PO366

Low Rates of Outpatient Intensified Hemodialysis in Pregnant Women with ESRD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Oliverio, Andrea L., University of Michigan, Ann Arbor, Michigan, United States
  • Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States
Background

Pregnancy is a rare event for women on hemodialysis (HD). Observational data suggests that increasing HD hours per week to >20-36hrs and targeting pre-HD BUN<50 during pregnancy improves likelihood of successful delivery. We aimed to characterize pre-delivery HD regimens of pregnant women with ESRD in the US and to identify patient characteristics associated with receipt of intensified HD.

Methods

Deliveries were identified using inpatient claims data from USRDS for all women age 18-44 undergoing HD with Medicare as primary payer in 2012-2015 (n=390). 41 weeks of preceding outpatient HD treatment data in CROWNWeb was examined, including: number of sessions per week, prescribed and delivered HD time, Kt/V, ultrafiltration rate, and pre-HD BUN. We stratified women into “intensified HD” group (5+ sessions per week; INT-HD) vs. “standard HD” (<5 sessions; STD-HD). Comparison of demographic and treatment variables were made for women receiving INT-HD vs. STD-HD using student’s t-test.

Results

There was no difference in age, ethnicity, or dialysis vintage of women who received INT-HD vs. STD-HD (Table), nor were there individual patient characteristics which predicted receipt of INT-HD. 39.2% of women in the STD-HD group did not achieve the recommended pre-HD BUN<50 compared to 17.2% of women in the INT-HD group (p<0.0001). Only 12.8% of women were dialyzed at least 5 times per week as outpatients, and less than 5% received ≥20 hrs (1200 minutes) per week. The average total treatment time per week for all delivering women was 745.5 min.

Conclusion

Experts advocate for at least 20 hours (if no residual renal function >36 hours) of HD per week in order to improve pregnancy outcomes. We observed that very few women with ESRD on HD in the US are receiving >20 hrs of HD per week in the outpatient setting and a significant proportion do not achieve the recommended pre-HD BUN.

Demographics and Treatment Characteristics in Delivering Women by Group

Funding

  • NIDDK Support