Prognosis of pregnant patients with renal failure undergoing blood purification therapy_West China Medical Journal

Authors：

LI Juan ^1,2 , WEI Yunbo ¹ ,  ZHOU Li ¹

1. Department of Nephrology / Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Division of Nephrology, the First People’s Hospital of Qujing, Qujing, Yunnan 202150, P. R. China;

Corresponding?author：

ZHOU Li, Email: 446125447@qq.com

Keywords：

Pregnancy; Chronic kidney disease; Blood purification; Prognosis

DOI：

10.7507/1002-0179.201806115

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Objective To observe the prognosis of pregnant patients with renal failure who underwent blood purification. Methods Pregnant patients with renal failure undergoing blood purification (hemodialysis or hemofiltration) from January 2009 to February 2017 were included in this study. Clinical data and pregnancy outcome were collected retrospectively. Results A total of 42 patients were enrolled in this study, including 38 with acute renal failure, 3 with chronic progressed renal failure, and 1 with chronic renal failure. There were 5 patients (11.9%) with chronic kidney disease (CKD) before pregnancy, 3 (7.2%) with systemic lupus erythematosus, 24 (54.8%) with hypertension, 5 (11.9%) with acute pancreatitis, and 7 (14.3%) with acute liver failure. In perinatal period, 7 patients (16.7%) died, whose underlying diseases were acute pancreatitis in 2, lupus nephritis in 1, acute hepatic failure in 3, and pulmonary tuberculosis breakout in 1. There were 5 patients with twin pregnancy, and 37 patients with single pregnancy. In the 28 patients with natural pregnancy ending, the live birth rate was 82.1% (23/28), and the live birth rate of twin pregnancy was only 50% (5/10). Twenty-seven patients were followed up, in whom 10 were in end stage of renal disease (ESRD), which was correlated with hypertension (P=0.001), and 3 patients were in CKD 1–4. Renal diseases were completely recovered in 14 patients. New CKD were diagnosed in 8 patients, without any correlated factor. Conclusions For pregnant patients with renal failure undergoing hemodialysis or hemofiltration, the death risk and the dead birth rate are high. Patients with hypertension or pre-existed renal failure have higher risk for ESRD. Some patients are not completely recovered from acute renal failure, with CKD left.

Citation： LI Juan, WEI Yunbo, ZHOU Li. Prognosis of pregnant patients with renal failure undergoing blood purification therapy. West China Medical Journal, 2018, 33(7): 877-880. doi: 10.7507/1002-0179.201806115 Copy

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6.	Piccoli GB, Arduino S, Attini R, et al. Multiple pregnancies in CKD patients: an explosive mix. Clin J Am Soc Nephrol, 2013, 8(1): 41-50.
7.	Kamal EM, Behery MM, Sayed GA, et al. RIFLE classification and mortality in obstetric patients admitted to the intensive care unit with acute kidney injury: a 3-year prospective study. Reprod Sci, 2014, 21(10): 1281-1287.
8.	Bouaziz M, Chaari A, Turki O, et al. Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit. Ren Fail, 2013, 35(9): 1210-1215.
9.	Prakash J, Ganiger VC, Prakash S, et al. Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014-2016). J Nephrol, 2018, 31(1): 79-85.
10.	趙郁虹, 吉凱強, 臧彬, 等. ICU 妊娠重癥患者預后中慢性腎臟病的發病情況及相關影響因素分析. 中國全科醫學, 2013, 16(32): 3798-3801.
11.	Piccoli GB, Cabiddu G, Castellino S, et al. A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy. J Nephrol, 2017, 30(3): 307-317.
12.	Bartsch E, Medcalf KE, Park AL, et al. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ, 2016, 353: i1753.
13.	Piccoli GB, Cabiddu G, Attini R, et al. Risk of adverse pregnancy outcomes in women with CKD. J Am Soc Nephrol, 2015, 26(8): 2011-2022.

1. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
2. Cabiddu G, Castellino S, Gernone G, et al. A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy. J Nephrol, 2016, 29(3): 277-303.
3. G?testam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis, 2016, 75(5): 795-810.
4. Flint J, Panchal S, Hurrell A, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford), 2016, 55(9): 1693-1697.
5. 南京總醫院, 國家腎臟疾病臨床醫學研究中心. 慢性腎臟病患者妊娠管理指南. 中華醫學雜志, 2017, 97(46): 3604-3611.
6. Piccoli GB, Arduino S, Attini R, et al. Multiple pregnancies in CKD patients: an explosive mix. Clin J Am Soc Nephrol, 2013, 8(1): 41-50.
7. Kamal EM, Behery MM, Sayed GA, et al. RIFLE classification and mortality in obstetric patients admitted to the intensive care unit with acute kidney injury: a 3-year prospective study. Reprod Sci, 2014, 21(10): 1281-1287.
8. Bouaziz M, Chaari A, Turki O, et al. Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit. Ren Fail, 2013, 35(9): 1210-1215.
9. Prakash J, Ganiger VC, Prakash S, et al. Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014-2016). J Nephrol, 2018, 31(1): 79-85.
10. 趙郁虹, 吉凱強, 臧彬, 等. ICU 妊娠重癥患者預后中慢性腎臟病的發病情況及相關影響因素分析. 中國全科醫學, 2013, 16(32): 3798-3801.
11. Piccoli GB, Cabiddu G, Castellino S, et al. A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy. J Nephrol, 2017, 30(3): 307-317.
12. Bartsch E, Medcalf KE, Park AL, et al. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ, 2016, 353: i1753.
13. Piccoli GB, Cabiddu G, Attini R, et al. Risk of adverse pregnancy outcomes in women with CKD. J Am Soc Nephrol, 2015, 26(8): 2011-2022.

West China Medical Journal

Prognosis of pregnant patients with renal failure undergoing blood purification therapy

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