Hemodiyaliz Tedavisi Alan Hastalarda Gebelik ve Kanıta Dayalı Tedavi Bakım Uygulamaları
Özet
Son dönem böbrek yetmezliği olan kadınlarda gebelik uzun yıllar boyunca istisnai bir durum olarak değerlendirilmiş, hatta imkânsız kabul edilmiştir. Ancak diyaliz tedavisinde kaydedilen teknolojik ve klinik ilerlemelerle birlikte bu yaklaşım önemli ölçüde değişmiştir. Artan diyaliz etkinliği, iyileştirilen hematolojik ve metabolik parametreler ile multidisipliner gebelik izlemi, hemodiyaliz altındaki kadınlarda fertilite ve doğum sonuçlarının iyileşmesine katkı sağlamıştır. Literatürde son yirmi yılda bildirilen gebelik ve canlı doğum oranlarındaki artış, bu alanda güncel bilgi ve deneyimlerin paylaşılmasını gerekli kılmaktadır. Bu bölüm, hemodiyaliz tedavisi gören kadınlarda gebelik olasılığını, yönetimini ve klinik sonuçlarını kapsamlı şekilde ele almak amacıyla yazılmıştır.
Referanslar
Sipahi S, Yaylacı S, Genc AB, ve ark. Son dönem böbrek yetersizliği nedeniyle hemodiyaliz tedavisi gören hastada gebelik: Olgu sunumu. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi, 2012; 21(1):89-91.
Jesudason S, Grace BS, McDonald SP. Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD. Clinical Journal of the American Society of Nephrology, 2014; 9(1): 143-149. doi: 10.2215/CJN.03560413.
Ng HJ, Tan WJ, Mooppil N, et al. Prevalence and patterns of depression and anxiety in hemodialysis patients: A 12‐month prospective study on incident and prevalent populations. British Journal of Health Psychology, 2015; 20(2): 374-395. doi: 10.1111/bjhp.12106.
Kara E, Isleem M, Döner B. Diyaliz hastasında gebelik: periton diyalizi veya hemodiyaliz Ünsal A, editör. Periton Diyalizi içinde (s.38-44) 1. Baskı. Ankara: Türkiye Klinikleri; 2019.
Oliverio A L, Hladunewich M A. End-stage kidney disease and dialysis in pregnancy. Advances in Chronic Kidney Disease, 2020;27(6):477-485. doi:10.1053/j.ackd.2020.06.001.
Confortini P. Full term successful pregnancy and successful delivery in a patient on chronic haemodialysis. In Proc Europen Dialaysis Transplanation Assocation, 1971; 8:74-80.
Sachdeva M, Barta V, Thakkar J, et al. Pregnancy outcomes in women on hemodialysis: a national survey. Clinical Kidney Journal, 2017;10(2):276-281. doi: 10.1093/ckj/sfw130.
Toth-Manikowski SM, Crews D C. Race, pregnancy and ESKD. Journal of the American Society of Nephrology, 2019;30(12): 2280-2282. https://doi.org/10.1681/ASN.2019101038
Tangren J, Nadel M, Hladunewich MA. Pregnancy and end-stage renal disease. Blood Purification, 2018; 45(1-3): 194-200. doi: 10.1159/000485157
Shahir AK, Briggs N, Katsoulis J et al. An observational outcomes study from 1966–2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology, 2013; 18(4): 276-284. doi: 10.1111/nep.12044.
Piccoli GB, Minelli F, Versino E. et al. Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrology Dialysis Transplantation, 2016; 31(11):1915-1934. doi: 10.1093/ndt/gfv395.
Shah S, Christianson AL, Meganathan K, et al. Racial differences and factors associated with pregnancy in ESKD patients on dialysis in the United States. Journal of the American Society of Nephrology, 2019; 30(12): 2437-2448. doi: 10.1681/ASN.2019030234
Barua M, Hladunewich M, Keunen J, et al. Successful pregnancies on nocturnal home hemodialysis. Clinical Journal of the American Society of Nephrology, 2008; 3(2):392-396. doi: 10.2215/CJN.04110907
Wiles KS, Nelson-Piercy C, Bramham K. Reproductive health and pregnancy in women with chronic kidney disease. Nature Reviews Nephrology, 2018;14(3):165-184. https://doi.org/10.1038/nrneph.2017.187
Baouche H, Jais JP, Meriem S, et al. Pregnancy in women on chronic dialysis in the last decade (2010–2020): A systematic review. Clinical Kidney Journal, 2023; 16(1):138-150. https://doi.org/10.1093/ckj/sfac204
Baouche H, Couchoud,C, Boulanger H, et al. Pregnancy Among Women Receiving Chronic Dialysis in France (2006–2020). Kidney International Reports, 2024; 9(8): 2432-2442. doi: 10.1016/j.ekir.2024.05.008
Stephanie M, Toth-Manikowski Deidra C, Crews Race. Pregnancy and ESKD, Journal of the American Society of Nephrology, 2019;30:2280–2282. https://doi.org/10.1681/ASN.2019101038
Michelle AH, Susan H Ayodele O, et al. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. Journal of the American Society of Nephrology. 2014;25(5):1103–1109. 10.1681/ASN.2013080825
Chakhtoura Z, Meunier M, Caby J, et al. Gynecologic follow up of 129 women on dialysis and after kidney transplantation: a retrospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2015;187:1-5. https://doi.org/10.1016/j.ejogrb.2015.01.004
Hladunewich MA, Hou S, Odutayo A, et al. Intensive hemodialysis associates with improved pregnancy outcomes: A Canadian and United States cohort comparison. Journal of the American Society of Nephrology, 2014; 25(5): 1103-1109. doi:10.1681/ASN.2013080825
Nadeau-Fredette AC, Hladunewich M, Hui D, et al. End-stage renal disease and pregnancy. Advances in Chronic Kidney Disease, 2013;20(3):246-252. doi: 10.1053/j.ackd.2013.01.010.
Palmer BF, Clegg DJ. Gonadal dysfunction in chronic kidney disease. Reviews in Endocrine and Metabolic Disorders, 2017; 18:117-130. doi: 10.1007/s11154-016-9385
Dumanski SM, Ahmed SB. Fertility and reproductive care in chronic kidney disease. Journal of Nephrology, 2019; 32(1): 39-50. doi: 10.1007/s40620-018-00569-9
Matuszkiewicz-Rowińska J, Skórzewska K, Radowick S, et al. Endometrial morphology and pituitary-gonadal axis dysfunction in women of reproductive age undergoing chronic haemodialysis—a multicentre study. Nephrology Dialysis Transplantation, 2004;19(8): 2074-2077. https://doi.org/10.1093/ndt/gfh279
Lin CT, Liu XN, Xu HL, et al. & Sui, H. Y. Menstrual disturbances in premenopausal women with end-stage renal disease: a cross-sectional study. Medical Principles and Practice, 2016; 25(3): 260-265. https://doi.org/10.1159/000444879
Steiner AZ, Pritchard D, Stanczyk FZ, et al. Association between biomarkers of ovarian reserve and infertility among older women of reproductive age. Jama, 2017; 318(14):1367-1376. doi:10.1001/jama.2017.14588
Bailie GR, Elder SJ, Mason NA. et al. Sexual dysfunction in dialysis patients treated with antihypertensive or antidepressive medications: results from the DOPPS. Nephrology Dialysis Transplantation, 2007;22(4):1163-1170. https://doi.org/10.1093/ndt/gfl755
Strippoli GF, Depression C. Sexual dysfunction in women with ERD requiring hemodialysis. Clinical Journal of the American Society of Nephrology, 2012; 7(6): 974-981. doi: 10.2215/CJN.12601211
Van Ek GF, Krouwel E M, Nicolai MP, et al. What is the role of nephrologists and nurses of the dialysis department in providing fertility care to CKD patients? A questionnaire study among care providers. International Urology and Nephrology, 2017; 49: 1273-1285. doi:10.1007/s11255-017-1577-z
Tan LK, Kanagalingam D, Tan HK, et al. Obstetric outcomes in women with end-stage renal failure requiring renal dialysis. International Journal of Gynecology & Obstetrics, 2006; 94(1):17-22. https://doi.org/10.1016/j.ijgo.2006.03.033
Van Eps C, Hawley C, Jeffries J, et al. Changes in serum prolactin, sex hormones and thyroid function with alternate nightly nocturnal home haemodialysis. Nephrology, 2012;17(1):42-47. https://doi.org/10.1111/j.1440-1797.2011.01520.x
Haninger-Vacariu N, Herkner H, Lorenz M, et al. Exclusion of pregnancy in dialysis patients: Diagnostic performance of human chorionic gonadotropin. BMC Nephrology, 2020; 21: 1-10. https://doi.org/10.1186/s12882-020-01729-5
Schwarz A, Post KG, Keller F, et al. Value of human chorionic gonadotropin measurements in blood as a pregnancy test in women on maintenance hemodialysis. Nephron, 1985;39(4):341-43. https://doi.org/10.1159/000183402
Kural A, Helvacıoğlu Ç, Murat E, ve ark. Persistent elevated β HCG in a non pregnant patient with chronic renal insufficiency. A rare case leading a misdiagnosis of ectopic pregnancy. Türk Klinik Biyokimya Dergisi, 2015;13(3): 114-118.
Puddu M, Migueliz ML, Rosa-Diez G, et al. High volume on line hemodiafiltration in dialysis pregnant patients: predilutional or postdilutional? Journal of Artificial Organs, 2021; 24: 392-397. https://doi.org/10.1007/s10047-020-01226-4
Haase M, Morgera, S, Bamberg C, et al. A systematic approach to managing pregnant dialysis patients—the importance of an intensified haemodiafiltration protocol. Nephrology Dialysis Transplantation, 2005;20(11):2537-2542. https://doi.org/10.1093/ndt/gfi044
Bamberg C, Diekmann F, Haase M, et al. Pregnancy on intensified hemodialysis: fetal surveillance and perinatal outcome. Fetal Diagnosis and Therapy, 2007; 22(4), 289-293. https://doi.org/10.1159/000100793
Bahadi A, El Kabbaj D, Guelzim K, et al. Pregnancy during hemodialysis: a single center experience. Saudi Journal of Kidney Diseases and Transplantation, 2010; 21(4):646-651.
Dheir H, Güngör Ö, Ulu MS, et al. Pregnancy and its outcomes in hemodialysis patients in Turkey. Turkish Journal of Medical Sciences, 2022; 52(2): 354-360. doi: 10.55730/1300-0144.5322
Hladunewich MA, Hou S, Odutayo A, et al. Intensive hemodialysis associates with improved pregnancy outcomes: A Canadian and United States cohort comparison. Journal of the American Society of Nephrology, 2014;25(5):1103-1109. doi: 10.1681/ASN.2013080825
Furaz-Czerpak KR, Fernández-Juárez,G, Moreno-de la Higuera, M, et al. Embarazo en mujeres en diálisis crónica: revisión. Nefrología (Madrid), 2012; 32(3): 287-294. doi:10.3265/Nefrologia.pre2012.Jan.11319
Eroğlu D, Lembet A, Özdemir FN. ve ark. Pregnancy during hemodialysis: perinatal outcome in our cases. Transplantation proceedings, 2004 January 36(1): 53-55. https://doi.org/10.1016/j.transproceed.2003.11.002
Luders C, Castro MCM, Titan SM, et al. Obstetric outcome in pregnant women on long-term dialysis: A case series. American Journal of Kidney Diseases, 2010; 56(1):77-85. https://doi.org/10.1053/j.ajkd.2010.01.018
Ikizler TA, Flakoll P J, Parker R A, et al. Amino acid and albumin losses during hemodialysis. Kidneyİnternational, 1994;46(3):830-837. https://doiorg/10.1038/ki.1994.339
Wiles KS, Bramham K, Vais A, et al. Pre-pregnancy counselling for women with chronic kidney disease: A retrospective analysis of nine years’ experience. BMC Nephrology, 2015;16:1-7. https://doi.org/10.1186/s12882-015-0024-6
Chou CY, Ting IW, Lin TH, et al. Pregnancy in patients on chronic dialysis: A single center experience and combined analysis of reported results. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2008; 136(2):165-170. doi: https://doi.org/10.1016/j.ejogrb.2007.01.017
Walfisch A, Al-Maawali A, Moretti ME, et al. Teratogenicity of angiotensin converting enzyme inhibitors or receptor blockers. Journal of Obstetrics and Gynaecology, 2011;31(6):465-472. doi: https://doi.org/10.3109/01443615.2011.579197
Piccoli GB, Conijn A, Consiglio V, et al. Pregnancy in dialysis patients: is the evidence strong enough to lead us to change our counseling policy?. Clinical Journal of the American Society of Nephrology, 2010; 5(1), 62-71. doi:10.2215/CJN.05660809
Asamiya Y, Otsubo S, Matsuda Y, et al. The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney İnternational, 2009;75(11):1217-1222. https://doi.org/10.1038/ki.2009.48
Roberge S, Villa P, Nicolaides K, et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: A systematic review and meta-analysis. FetalDiagnosisandTherapy, 2012;31(3):141-146. https://doi.org/10.1159/000336662
Gomes S, Lope C., Pinto E. Folate and folic acid in the periconceptional period: recommendations from official health organizations in thirty-six countries worldwide and WHO. PublicHealthNutrition, 2016;19(1):176-189. https://doi.org/10.1017/S1368980015000555
Hladunewich MA, Hou S, Odutayo A, et al. Intensive hemodialysis associates with improved pregnancy outcomes: A Canadian and United States cohort comparison. Journal of the American Society of Nephrology, 2014; 25(5):1103-1109. doi: 10.1681/ASN.2013080825
Shan HY. Rana S, Epstein, FH, et al. Use of circulating antiangiogenic factors to differentiate other hypertensive disorders from preeclampsia in a pregnant woman on dialysis. American Journal of Kidney Diseases, 2008;51(6):1029-1032. https://doi.org/10.1053/j.ajkd.2008.03.011
Cornelis T, Spaanderman M, Beerenhout C, et al. Antiangiogenic factors and maternal hemodynamics during intensive hemodialysis in pregnancy. Hemodialysis International, 2013; 17(4): 639-643. doi:https://doi.org/10.1111/hdi.12042
Piccoli GB, Gaglioti P, Attini R, et al. Pre-eclampsia or chronic kidney disease? The flow hypothesis. Nephrology Dialysis Transplantation, 2013; 28(5). 1199-1206. https://doi.org/10.1093/ndt/gfs573
Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: A systematic review. Hypertension in Pregnancy, 2002; 21(1): 85-95. https://doi.org/10.1081/PRG-120002912