Dialysis in pregnancy

Renal replacement therapy (RRT) during pregnancy, while uncommon, should not be considered a rarity and in fact appears to be occurring more frequently with changing demographics and advancements in the obstetrical care of women with kidney disease. Options for dialysis include hemodialysis (HD) and peritoneal dialysis (DP). HD uses a vascular access to perform extracorporeal circulation of blood through an artificial membrane. PD does not require vascular access but instead uses the body’s peritoneal membrane to provide clearance. Pregnancy outcomes appear to be better in women who initiate dialysis during pregnancy versus those who are already on dialysis at conception. Anemia develops during pregnancy largely due to an increase in plasma volume of 3-4?L without a corresponding increase in red cell mass. Care during pregnancy for patients on dialysis should include a multidisciplinary team with a nephrologist and maternal-fetal medicine specialist.