Dialysis and pregnancy: no longer the impossible

Nephrology Dialysis Transplantation, Nov 2016

Kate Bramham

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Dialysis and pregnancy: no longer the impossible

0 The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved 1 Department of Renal Medicine, Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine 2 King's College London , London , UK essential part of good clinical care. This does not imply, however, that early detection alone equals good clinical care and is sufficient to optimize outcomes for patients affected by AKI. The results presented in this article have not been published previously in whole or part. The authors report no conflict of interest related to the content of this article. Kate Bramham Correspondence and offprint requests to: Kate Bramham; E-mail: Pregnancy in women with renal disease provokes anxiety in nephrologists and obstetricians alike. Chronic kidney disease (CKD) is associated with some of the highest rates of adverse maternal and neonatal outcomes compared with other preexisting medical conditions in women of childbearing age. Women with advanced CKD also are at risk of disease progression, hastening the requirement for renal replacement therapy, shortening their life expectancy and potentially restricting their - C O N F L I C T O F I N T E R E S T S T A T E M E N T R E F E R E N C E S 1. Selby NM, Hill R, Fluck RJ. Standardizing the early identification of acute kidney injury: the NHS England national patient safety alert. Nephron 2015; 131: 113–117 2. Flynn N, Dawnay A. A simple electronic alert for acute kidney injury. Ann Clin Biochem 2015; 52: 206–212 3. Porter CJ, Juurlink I, Bisset LH et al. A real-time electronic alert to improve detection of acute kidney injury in a large teaching hospital. Nephrol Dial Transplant 2014; 29: 1888–1893 4. Sawhney S, Fluck N, Marks A et al. Acute kidney injury—how does auto mated detection perform? Nephrol Dial Transplant 2015; 30: 1853–1861 5. Prendecki M, Blacker E, Sadeghi-Alavijeh O et al. Improving outcomes in patients with acute kidney injury: the impact of hospital based automated AKI alerts. Postgrad Med J 2016; 92: 9–13 6. Colpaert K, Hoste EA, Steurbaut K et al. Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class. Crit Care Med 2012; 40: 1164–1170 7. Wilson FP, Shashaty M, Testani J et al. Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial. Lancet 2015; 385: 1966–1974 8. Kolhe N, Reilly T, Leung J et al. A simple care bundle for use in acute kidney injury: a propensity-matched cohort study. Nephrol Dial Transplant 2016; 31: 1846–1854 9. Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary ( part 1). Crit Care 2013; 17: 204 10. Horne KL, Selby NM. Recent developments in electronic alerts for acute kidney injury. Curr Opin Crit Care 2015; 21: 479–484 11. Kashani K, Herasevich V. Utilities of electronic medical records to improve quality of care for acute kidney injury: past, present, future. Nephron 2015; 131: 92–96 12. Basu RK, Gist K, Wheeler DS. Improving acute kidney injury diagnostics using predictive analytics. Curr Opin Crit Care 2015; 21: 473–478 13. Lin J, Fernandez H, Shashaty MG et al. False-positive rate of AKI using con sensus creatinine-based criteria. Clin J Am Soc Nephrol 2015; 10: 1723–1731 14. Cruz DN, Ferrer-Nadal A, Piccinni P et al. Utilization of small changes in serum creatinine with clinical risk factors to assess the risk of AKI in critically ill adults. Clin J Am Soc Nephrol 2014; 9: 663–672 15. Stewart J, Findlay G, Smith N et al. Adding insult to injury: a review of the care of patients who died in hospital with a primary diagnosis of acute kidney injury (acute renal failure). A report by the National Confidential Enquiry into Patient Outcome and Death. http://www.ncepod.org.uk/2009aki. html 16. Goldstein SL. Automated/integrated real-time clinical decision support in acute kidney injury. Curr Opin Crit Care 2015; 21: 485–489 17. Kellum JA, Kane-Gill SL, Handler SM. Can decision support systems work for acute kidney injury? Nephrol Dial Transplant 2015; 30: 1786–1789 Received for publication: 20.4.2016; Accepted in revised form: 20.4.2016 Dialysis and pregnancy: no longer the impossible ability to care for their children, who may have complex health needs secondary to prematurity. Thus, many women with advanced CKD have been advised strongly not to conceive [1] or to wait for a kidney transplant before contemplating pregnancy. Following the first live birth reported in a woman receiving haemodialysis in 1971 [2], the number of successful pregnancy outcomes in women with end-stage renal disease (ESRD) has been increasing, and a recent exponential rise in reported pregnancies is highlighted by Piccoli et al. in this issue of NDT [3]. Ninety pregnancies in women receiving haemodialysis were identified between 2000 and 2008 [4], and in the following 6 years an additional (...truncated)


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Kate Bramham. Dialysis and pregnancy: no longer the impossible, Nephrology Dialysis Transplantation, 2016, pp. 1763-1765, 31/11, DOI: 10.1093/ndt/gfw216