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Pregnancies in Women With Kidney Failure on Home Dialysis in the United States. | LitMetric

AI Article Synopsis

  • Women with kidney failure on home dialysis experience impaired fertility and increased risks during pregnancy; however, insights into their pregnancies remain limited.
  • A study analyzed 26,387 women aged 15 to 49 from 2005 to 2018, revealing a pregnancy rate of 8.6 per 1000 person-years, with higher rates in those using home hemodialysis compared to peritoneal dialysis.
  • Factors influencing pregnancy likelihood included age (lower rates in older women) and race (higher likelihood for Black women), while socioeconomic status and other logistical factors did not significantly impact pregnancy rates.

Article Abstract

Introduction: Women with kidney failure have impaired fertility and are at a higher risk of maternal and fetal morbidity and mortality. Little is known about pregnancies in women receiving maintenance home dialysis in the United States.

Methods: Using data from the United States Renal Data System (USRDS), a cohort of 26,387 women aged 15 to 49 years with kidney failure receiving maintenance home dialysis from 2005 to 2018 was examined. We calculated pregnancy rates and identified factors, including the modality associated with pregnancy receiving home dialysis.

Results: Overall, 437 pregnancies were identified in 26,837 women on home dialysis. The unadjusted pregnancy rate was 8.6 per 1000 person-years (PTPY). The unadjusted pregnancy rate was higher on home hemodialysis (16.0 vs. 7.5 PTPY) than on peritoneal dialysis. Women receiving home hemodialysis had a higher adjusted likelihood of pregnancy than women receiving peritoneal dialysis (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.79-3.05). Compared with women aged 20 to 24 years, the likelihood of pregnancy was lower in women aged 30 to 34 years (HR, 0.64; 95% CI, 0.43-0.96), 35 to 39 years (HR, 0.53; 95% CI, 0.35-0.79), 40 to 44 years (HR, 0.32; 95% CI, 0.21-0.49), and 45 to 49 years (HR, 0.21; 95% CI, 0.13-0.33). Whereas Black women had a higher likelihood of pregnancy (HR, 1.40; 95% CI, 1.07-1.83), there was no difference in likelihood of pregnancy in Asian, Hispanic, and Native Americans as compared to Whites. Body mass index, cause of kidney failure, socioeconomic status, rurality, predialysis nephrology care, or dialysis vintage were not significantly associated with pregnancy on home dialysis.

Conclusion: The pregnancy rate in women with kidney failure undergoing home dialysis is higher with home hemodialysis than with peritoneal dialysis. Younger age and Black race or ethnicity are associated with a higher likelihood of pregnancy among women receiving home dialysis. This information can guide clinicians in preconception counselling and making informed treatment decisions for pregnant women on home dialysis.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11101807PMC
http://dx.doi.org/10.1016/j.ekir.2024.01.045DOI Listing

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