Friday, 21 February 2014

Dialysis for Pregnant Women with Kidney Failure

A study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN) concludes that intensive dialysis for pregnant women with failing kidneys results in a greater proportion of live births when compared with standard dialysis.

Pregnancy is considered dangerous if the mother-to-be has advanced kidney disease. Dangerous to both the mother and child. The study compared the live birth rate for a group who had received intensive dialysis treatment with the more general cases who had received standard dialysis treatment. With intensive hemodialysis the live birth rate was 86.4% (22 patients) while in the standard treatment group of 70 patients, the live birth rate was 61.4%. This was considered a significant improvement.

Among the findings of this Canadian study were the following:

In patients with established kidney failure at conception, the live birth rate in the group from Toronto was 83%, compared with only 53% in the American group.

The median duration of pregnancy in the more intensively dialyzed group of women from Toronto was 36 weeks compared with 27 weeks in American women.

A dose response between dialysis intensity and pregnancy outcomes occurred. For women dialyzed for more than 36 hours per week, the live birth rate was 85%, while it was only 48% in women dialyzed for 20 hours or less per week. Infants were a healthier weight at birth when women were dialyzed for more than 20 hours per week than when women were dialyzed for 20 hours or less per week.

Complications were few and manageable in women who received intensive dialysis.

“More intensive dialysis has improved pregnancy rates and dramatically improved pregnancy outcomes,” said Dr. Hladunewich, lead scientist in the study. “This study provides hope to young women on dialysis who might want to consider having a family.”


The Journal's online abstract can be found at

Friday, 14 February 2014

Canadian Society of Nephrology Changes Guidelines

A recent change to guidelines has appeared in the Canadian Medical Association Journal.

The articles talks about the timing of starting dialysis for sufferers of chronic kidney disease and how there is a need to identify a threshold before which starting dialysis offers no benefit to the patient but beyond which there may be some measurable risk.

Basically they suggest that a patient should not commence their dialysis treatment until their glomerular filtration rate drops to 6mL/minute per 1.73m2 or less, or clinical indications become evident. Close monitoring of the patient should begin when levels reach 15mL per minutes per 1.73m2

"Delaying dialysis in people without symptoms appears to be safe, as long as they are closely followed by their kidney specialist," lead author Gihad Nesrallah, MD, associate scientist at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, London, Ontario, Canada, said in a journal news release. "This approach is sure to be preferred by patients, who generally enjoy a better quality of life off dialysis than on it." 

THe spokesman also said that there did not seem to be any downside to delaying the start , assuming that it can be started promptly when required.

Apparently the report authors didn't consider any cost savings in making their guidelines, but did note that there would probably be a substantial saving made.

Previous guidelines placed more emphasis on laboratory tests than on patients' symptoms and recommended starting dialysis at higher eGFR rates for people with diabetes or a decline in nutritional status.

These recommendations were made after analysing 23 studies on  dialysis.