The Successful Outcome of Pregnancy in a Woman with End-Stage Renal Failure Chronically Hemodialyzed without Change of Treatment Regimen

Wojciech Krawczyk, MD, PhD, Department of Internal Medicine and Dialysis Unit, Regional Hospital,ul. Szpitalna 53, PL-22-100 Chełm (Poland) Table 1. Selected parameters during pregnancy Dear Sir, Despite increasingly better methods of renal replacement therapy and excellent he-modialysis techniques, pregnancy in chronically hemodialyzed patients occurs rather seldom [1,2]. Many factors influence the fertility in dialyzed women, among others reduced libido and sexual function, anemia and endocrinal abnormalities [2-4]. Pregnancies in patients with end-stage renal failure present a great risk for the mother (volume overload, exacerbation of hypertension, eclampsia), and for the infant (respiratory distress syndrome, leukopenia, thrombocy-topenia, reduced birth weight, adrenocorti-cal insufficiency, infection), with the likelihood of a live birth being, at best, 28-50% [1,2,4,5]. Therefore, to minimize these risks, many authors recommended an intensification of the dialysis therapy (to maintain a chemistry that is nearly as normal as possible), the beginning of peritoneal dialysis, rigid control of blood pressure, avoidance of rapid fluctuations in intravascular volume (interdia-lytic weight gain has to be limited to about 1 kg), careful monitoring of the calcium level and minimization of anemia by erythropoie-tin [2, 3, 6, 7]. Nevertheless, experience with the management of pregnancies in hemodialyzed women is limited. In our center we observed a successful pregnancy in a hemodialyzed woman without the necessity of changing the treatment regimen. The 22-year-old woman with end-stage renal failure due to chronic glomerulo-nephritis had been hemodialyzed at our center for 2 years. She had residual diuresis of about 100-200 ml/day. The dialysis protocols included 15 h of hemodialysis per week (dialyzers with cuprophane membrane, acetate dialysis fluid). The patient received ve-rapamil 120 mg per day (per os) and erythro-poietin 6,000 U per week (subcutaneously). She was in a very good clinical state of health, her menstrual cycle was regular and normal. In March 1994 she missed a period. A pregnancy was detected in the 14th week (confirmed by ultrasound scan). Because her general state of health, blood pressure and biochemical parameters were very good, the