Standardization Needed for Dialysis Initiation in Pregnancy

WEDNESDAY, July 23, 2025 (HealthDay News) — The initiation of dialysis in women with chronic kidney disease during pregnancy varies by clinical practice, signaling a need for standardized care in this population, according to a study published in the July issue of Kidney International Reports.

Jennifer H. Yo, M.B.B.S., M.P.H., from Monash Health in Melbourne, Australia, and colleagues examined dialysis initiation patterns in pregnancy in a multinational retrospective cohort study of women who delivered between Jan. 1, 2000, and Oct. 31, 2022. A total of 169 pregnancies in 149 women were included; eligible women had a prepregnancy estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² within 12 months of conception or a serum creatinine ≥150 μmol/L when first measured during pregnancy.

Overall, 46.7 percent of the women initiated dialysis during pregnancy at a median of 21.4 weeks of gestation. Regional differences were seen in initiation and dose (hours per week) of dialysis. The researchers found that women who started dialysis during pregnancy more often had adverse maternal and fetal outcomes than women who did not start dialysis during pregnancy. There were no significant associations seen between dialysis hours per week and adverse maternal and fetal outcomes. The mean change in eGFR at one year postpartum versus prepregnancy values was −8.4 mL/min/1.73 m² in women not on dialysis.

“Our study findings provide much needed contemporary data on dialysis initiation during pregnancy and the maternal and fetal outcomes within a cohort of women with advanced CKD,” the authors write. “The interclinician and regional differences in practice highlight the need for standardized care to optimize outcomes. Enhancing clinician education on prepregnancy counseling is essential, particularly in fostering proactive discussions about reproductive intentions and contraceptive needs.”

Abstract/Full Text