Protective hemodialysis in a pregnant woman with chronic kidney disease stage 4 A case report and literature review; [Протективный гемодиализ у беременной пациентки с 4 стадией хронической болезни почек Клиническое наблюдение и обзор литературы]

Pregnancy management in patients with CKD treated with hemodialysis remains an important interdisciplinary problem that unites the efforts of obstetrician-gynecologists and nephrologists. Currently, such a pregnancy is no longer a rarity. Despite the high incidence of complications for the woman and the fetus, the outcomes of such pregnancies are favorable in most cases with the use of a special dialysis regimen called intensive, which makes it possible to prolong the pregnancy until the birth of a live and viable child by lengthening the weekly dialysis time. Most often, intensive dialysis is used in patients who become pregnant while already receiving renal replacement therapy. There are significantly fewer publications on its onset in pregnant women with advanced CKD (3b-4 stages). As a rule, in such cases, the indication for RRT is not the maternal progression of renal failure but the prevention of the fetotoxic effect of urea on the fetus. This form of dialysis therapy is called protective hemodialysis. A feature of protective dialysis is a shorter duration of dialysis time compared to intensive HD, which is determined by the residual kidney function in a pregnant woman. Dialysis time is determined strictly individually and depends on the volume of diuresis and the ureaconcentration in the mother's blood. The following clinical observation illustrates the possibility of a favorable pregnancy outcome in a patient with stage 4 CKD, in whom protective dialysis was started due to a urea level of more than 20 mmol/l at 23 weeks. The use of an individualized approach made it possible to prolong the pregnancy up to 34 weeks and give birth to a viable child. After delivery, the patient remained dialysis-dependent, and after 10 months she underwent a kidney transplant. © 2022 JSC Vidal Rus. All rights reserved.