A systematic approach to managing pregnant dialysis patients—the importance of an intensified haemodiafiltration protocol

Sir, We read with interest the paper by Haase et al. [1] reporting five successful consecutive pregnancies in patients on maintenance dialysis, as it closely parallels our experience. We have indeed reported [2] seven consecutive pregnancies occurring between 1995 and 2001 in patients on dialysis for >1 year. The frequency and length of sessions, and haemoglobin targets, were systematically increased. One patient chose to terminate her pregnancy. The mean gestational age for the six other pregnancies was 31 weeks (24–34 weeks) with an average birth weight of 1495 g. One neonate born at 24 weeks died 2 days following delivery. Paediatric evaluation of the five other children showed a good outcome after up to 5.5 years. We must, however, disagree with the statement that haemodiafiltration is the preferred treatment in pregnancy, as all our patients were on haemodialysis. Further studies are certainly necessary to identify the importance of factors such as dialysis technique and biological targets, but lack of availability of haemodiafiltration should not be a deterrent to taking charge of these pregnancies. In our opinion, as in that of Haase et al., it is indeed the quality of the collaboration between obstetricians, paediatricians and nephrologists that determines the outcome of pregnancy in patients on maintenance dialysis.