Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study
-
Published:2022-03-28
Issue:6
Volume:35
Page:1689-1698
-
ISSN:1724-6059
-
Container-title:Journal of Nephrology
-
language:en
-
Short-container-title:J Nephrol
Author:
Jesudason ShilpanjaliORCID, Hewawasam Erandi, Moloney Brona, Tan Rachel, Li Joule, Blakey Hannah, Bramham Kate, Hall Matthew, Juneja Rajiv, Jarvis Elizabeth, Lightstone Liz, Lipkin Graham, Hladunewich Michelle A.
Abstract
Abstract
Background
Evidence surrounding vascular access options for commencing dialysis in pregnancy complicated by chronic kidney disease (CKD) is limited. Creation of new arteriovenous fistulas (AVFs) in pregnant women is rare.
Methods
Retrospective cohort study of approaches to vascular access in pregnancy in centres in Australia, the United Kingdom (UK) and Canada (2002–2018).
Results
Twenty-three women with advanced CKD commenced dialysis in pregnancy (n = 20) or planned to commence (n = 3). Access at dialysis start was a tunnelled catheter (n = 13), temporary catheter (n = 1), AVF created pre-conception but used in pregnancy (n = 3) and AVF created during pregnancy (n = 3). No women commencing dialysis with an AVF required a catheter. No differences in perinatal outcomes were observed comparing AVFs and catheters at dialysis commencement. No AVFs were created in pregnancy in Canadian women. From Australia and the UK, 10 women had a new AVF created in pregnancy, at median gestation 14.5 weeks (IQR 12.5, 20.75). Four women still needed a catheter for dialysis initiation and 3 eventually used the new AVF. Six AVFs were successfully used in pregnancy at median gestation 24 weeks (IQR 22.5, 28.5), 2 were successfully created but not used and 2 had primary failure. No catheter-associated complications were identified except one episode of catheter-related sepsis.
Conclusions
Catheter-related complications were minimal. In selected women, with sufficient pre-planning, an AVF can be created and successfully used during pregnancy to minimise catheter use if preferred. Pre-conception counselling in advanced CKD should include discussing vascular access options reflecting local expertise and patient preferences.
Graphic abstract
Funder
The University of Adelaide
Publisher
Springer Science and Business Media LLC
Reference32 articles.
1. Jesudason S, Grace BS, McDonald SP (2014) Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD. Clin J Am Soc Nephrol CJASN 9(1):143–149 2. Wiles K, Webster P, Seed PT, Bennett-Richards K, Bramham K, Brunskill N, Carr S, Hall M, Khan R, Nelson-Piercy C et al (2020) The impact of chronic kidney disease stages 3–5 on pregnancy outcomes. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 36:2008–2017 3. Shah S, Christianson AL, Meganathan K, Leonard AC, Schauer DP, Thakar CV (2019) Racial differences and factors associated with pregnancy in ESKD patients on dialysis in the United States. J Am Soc Nephrol 30(12):2437–2448 4. Hewawasam E, Davies CE, Gulyani A, Li Z, Clayton PA, Sullivan E, McDonald SP, Jesudason S (2021) Factors influencing fertility rates in Australian women receiving kidney replacement therapy: analysis of linked ANZDATA registry and perinatal data over 22 years. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfab157 5. Piccoli GB, Minelli F, Versino E, Cabiddu G, Attini R, Vigotti FN, Rolfo A, Giuffrida D, Colombi N, Pani A et al (2016) Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 31(11):1915–1934
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|