Pregnancy in ESKD

Pregnancy in ESKD: Dialysis Modality, Intensive Hemodialysis, and Multidisciplinary Care

Peritoneal Dialysis InternationalHosts Dr. Nikhil Shah and Dr. Jeff Perl discuss pregnancy in the ESKD population featured in the May issue of Peritoneal Dialysis International with experts Dr. Michelle Hladunewich and Dr. Ghada Ankawi. They review counseling young women starting kidney replacement therapy about family planning, transplant wait times, and modality choice, noting pregnancy is about half as likely on peritoneal dialysis as on hemodialysis. Intensive hemodialysis improves fertility and yields live birth rates and gestational ages similar to transplantation, though babies remain smaller; contraception is important for women not desiring pregnancy. They address equity and logistical barriers to intensifying dialysis, individualized management including hybrid PD/HD, the role of residual kidney function, monitoring issues such as dry weight, hypotension, anemia/ESA needs, phosphate, and polyhydramnios, and use of sFlt-1/PlGF ratio to aid preeclampsia diagnosis. The episode emphasizes OB-nephrology collaboration, multidisciplinary supports, postpartum planning, and establishing pregnancy–kidney disease clinics.00:00 Show Intro And Guests02:37 Why Pregnancy Nephrology03:58 Building Pregnancy Clinics05:51 Family Planning On Dialysis07:29 PD Versus HD Fertility10:42 Intensive Dialysis Outcomes12:59 Saudi Experience And Home HD14:26 When Pregnancy Is Detected17:32 Monitoring And Dry Weight20:56 Staying On PD Or Hybrid25:18 Shared Decision PD Case25:53 PD Pregnancy Success Story27:20 Residual Function Matters29:01 Diagnosing Preeclampsia29:26 Placenta Biomarkers Explained31:57 Building A Pregnancy Clinic33:53 Making OB Collaboration Work36:50 Multidisciplinary Team Support38:27 Dialysis Pregnancy Rapid Fire41:23 Postpartum Counseling And Support46:17 Wrap Up And Takeaways