Dr Sagun Banjade1, Dr Melanie Wyld2,3, Erin Vaughan4, Su Jen Chua5,6, Chris Davies7, Prof Shilpanjali Jesudason7,8,9
1Department of Obstetrics and Gynaecology, Southern Adelaide Local Health Network. Flinders Medical Centre, , Australia, 2Department of Renal Medicine, Westmead Hospital, Westmead, Australia, 3Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 4Royal Prince Alfred Hospital , Camperdown , Australia, 5Department of Obstetric Medicine, Mercy Hospital, Heidelberg , Australia, 6Evidenced based Women’s Health Care Research Group, Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia, 7Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Royal Adelaide Hospital, Adelaide, Australia, 8Central and Northern Renal and Transplantation Service, Adelaide, Australia, 9Department of Medicine, University of Adelaide, Adelaide, Australia
Biography:
Sagun is a general medicine physician and obstetric medicine physician with a special interest in chronic disease in pregnancy.
Background:
Pregnancy in women undergoing home dialysis is uncommon despite potential advantages, including extended dialysis hours, greater family support, and reduced hospital resource utilisation. Limited data may contribute to clinician and patient hesitancy in considering home dialysis during pregnancy.
Aim:
To examine fertility rates, pregnancy outcomes, and dialysis modality transitions in women receiving home dialysis
Methods:
A retrospective analysis of all pregnancies reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry between 2001-2023 was conducted.
Results:
A total of 149 pregnancies were identified. Fertility rates per 1000 women/year were 3.6 for home haemodialysis (HHD), 1.1 for peritoneal dialysis (PD), and 2.6 for in-centre dialysis (ICD).
Dialysis modality at conception included 20(13.4%) HHD; 13(8.7%) PD, and 53(35.6%) ICD. 63 (57%) pregnancies were conceived before dialysis (CBD). Median dialysis duration at conception was shortest for PD (0.6 years Interquartile Range, IQR 0.6-2.9), followed by ICD (1.3 years IQR 0.6-2.9) and HHD (3.6 years IQR 2.2-6.0) (p=0.017). Initial dialysis modality was mostly continued (85% HHD, 84.6% PD, 86.8% ICD). Among CBD, 3(4.8%) commenced home dialysis during pregnancy.
Preeclampsia rates were highest in PD (38.5%) and CBD (33.3%), compared to HHD (14.3%) and ICD (10%) (p=0.007). Live birth rates were similar across dialysis modalities ((HHD:47.8%;PD:50%;ICD:47.2%). Median gestational age and birthweight did not differ significantly between modalities at delivery. Among those with dialysis vintage >3 years, median birthweight was lowest on PD (959g), compared to HHD (1885g) and ICD (1584g) (p=0.07).
Conclusion:
Conclusion: This study demonstrates successful pregnancy outcomes in women undergoing home dialysis, including those who initiate it during pregnancy. These findings support broader consideration of home dialysis as a viable option during pregnancy.