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Abstract: PO0819

Novel Insight About Pregnancy in Women on Chronic Dialysis: Systematic Review and Meta-Analysis Correlating Dialysis Regimen and Pregnancy Outcome

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Cataldo, Emanuela, Nephrology and Dialysis Unit, “Fabio Perinei Hospital”, Bari, Italy
  • Longhitano, Elisa, Universita degli Studi di Messina Dipartimento di Medicina Clinica e Sperimentale, Messina, Sicilia, Italy
  • Torreggiani, Massimo, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
  • Chatrenet, Antoine, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
  • Gesualdo, Loreto, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Puglia, Italy
  • Piccoli, Giorgina B., Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
Background

Pregnancy in women on dialysis is an uncommon event, with a high rates of preterm delivery and neonatal death. Guidelines for management of dialysis in pregnancy are still lacking. Our aim is to identify dialysis regimens associated with best maternal-fetal outcomes

Methods

Rapid systematic review. MEDLINE, EMBASE and COCHRANE library were searched (1950–2019: free terms on pregnancy and dialysis). Meta-analysis and metaregression were performed in case series dealing with the larger subset of haemodialysis (HD) patients (>5 patients on chronic HD)

Results

The descriptive of 5204 pregnancies in 4746 HD patients, out of 52 case series and registry data highlighted the importance of intensifying HD in pregnancy (5-6 sessions, >20 hours/week) to achieve a reduction in mortality and an increase in neonatal weight.
The meta-analysis showed an increased risk of preterm delivery in women on chronic HD, decreasesing with the increase in hours of HD and number of HD sessions. In addition, the meta regression demonstrated that increasing weekly hours of HD was associated to a lower risk of extreme preterm birth (<28 gestational weeks: p=0.016) and SGA (p=0.014) and with an increase in weight at birth (p<0.001). The same trend was observed for number of HD sessions. The high heterogeneity of data doesn't allow disentangling the effect of the center of care

Conclusion

Extendend hours HD regimens in pregnancy improve maternal fetal outcomes. This improvement is linked both to HD rhythm and duration.The results obtained during pregnancy lead to reconsidering the concept of adequate HD at least in the young population