A MEDICAL MILESTONE: SUCCESSFUL PREGNANCY AND DELIVERY IN A PATIENT WITH CKD STAGE 5 ON HAEMODIALYSIS

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A MEDICAL MILESTONE: SUCCESSFUL PREGNANCY AND DELIVERY IN A PATIENT WITH CKD STAGE 5 ON HAEMODIALYSIS

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Co-author 1

Dr Piyali Sarkar sarkar_drpiyali@yahoo.com Charnock Hospital Nephrology and Transplant Kolkata India *

Co-author 2

Dr Jayanta Datta drjayanta_datta@yahoo.co.in Charnock Hospital Nephrology and Transplant Kolkata India -

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Introduction

Pregnancy in patients with chronic kidney disease (CKD) Stage 5 undergoing haemodialysis is exceedingly rare and fraught with significant maternal and foetal risks. Suppressed reproductive hormones, metabolic instability, and placental insufficiency often preclude natural conception and successful gestation. This case report presents a remarkable instance of natural conception, sustained pregnancy, and successful delivery in a CKD Stage 5 patient on dialysis, highlighting the impact of high-quality care and multidisciplinary collaboration.

Methods

A female patient with CKD Stage 5 on maintenance haemodialysis presented with a spontaneous pregnancy. The following challenges were addressed:

Natural Conception: Despite the typical suppression of the hypothalamic-pituitary axis in CKD Stage 5, the patient conceived naturally, likely due to optimal dialysis quality and individual physiological factors.

Pregnancy Continuation: Standard guidelines recommend medical termination of pregnancy (MTP) in such cases due to high risk. After extensive counselling, the patient opted to continue the pregnancy, and her decision was supported by the care team.

Dialysis Management: To ensure maternal metabolic stability and adequate placental perfusion, the dialysis regimen was modified. Instead of conventional thrice-weekly sessions with high ultrafiltration volumes, the patient received daily, slow dialysis with minimal ultrafiltration, tailored to reduce the risk of intrauterine growth restriction (IUGR) and intrauterine foetal demise (IUFD).

Results

The patient successfully carried the pregnancy to term and delivered a healthy male infant via caesarean section. The baby weighed 2.1 kg at birth. Throughout the pregnancy, maternal and foetal parameters remained stable, with no major complications. The innovative dialysis schedule played a pivotal role in maintaining metabolic balance and foetal health.

Conclusion

This case underscores the potential for successful pregnancy outcomes in CKD Stage 5 patients with meticulous care and individualized treatment strategies. It challenges the conventional notion that CKD is incompatible with pregnancy and highlights the importance of:

Quality dialysis care Patient-centered decision-making Interdepartmental coordination

The collaboration between Nephrology, Obstetrics & Gynaecology, Paediatrics, and Anaesthesia departments was instrumental in achieving this outcome. This case serves as a beacon of hope and a reminder that with the right approach, even the most complex medical scenarios can yield life-affirming results.

Kewords