Hypertension and associated complications in pregnant women with chronic kidney disease

Table 2 Renal replacement therapy for pregnant chronic kidney disease patients

Renal replacement therapy
Initiation of dialysis	Blood urea of more than 17 mmoL/L even in the absence of any frank uremic symptoms or absolute indication of dialysis, to prevent foetal death due to azotemia
Haemodialysis vs peritoneal dialysis	Lesser data on successful pregnancy outcomes in peritoneal dialysis patients
	Increased abortion rate during insertion of Tenckhoff peritoneal dialysis catheter
	Challenges to keep the usual dwell volume during peritoneal dialysis. Due to lesser space in the third trimester because of gravid uterus dwell volume needs reductions with concomitant increase in the number of exchanges to achieve the desired clearance
	Peritoneal dialysis: More frequent exchanges to maintain desired BUN
	Tidal peritoneal dialysis helps in reducing drain pain and catheter drain dysfunction due to the gravid uterus
Dialysis adequacy	Target predialysis BUN < 12.5 mmoL/L in hemodialysis. No recommendation established for peritoneal dialysis
	Dialysis duration
	Patients with residual renal function > 20 hours/week
	Patients without residual renal function > 36 hours/week
	Kt/V assessment should not be used in pregnancy
Weekly dry weight assessment to account for weight gain during pregnancy	2nd trimester: 300 g/week weight gain
	3rd trimester: 300-500 g/week weight gain
Segmental bioimpedance for accurate assessment of volume status	It might prevent intradialytic hypotension and subclinical reduction in effective arterial blood volume, which might avert worsening of uteroplacental perfusion and improve foetal outcome
Haemodialysis prescription	Bicarbonate around 25 mmoL/L
	Potassium 3 mmoL/L or more
	Heparin is generally safe in pregnancy

BUN: Blood urea nitrogen.