Hemodialysis prescription in pregnancy give in poster form
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hemodialysis pregnancy prescription dialysis dose
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hemodialysis pregnancy outcomes
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Here is your comprehensive poster on Hemodialysis Prescription in Pregnancy, drawn from three authoritative nephrology and maternal-fetal medicine textbooks. Key highlights:
Key Points Covered in the Poster
When to Initiate
- Discuss dialysis when BUN >42 mg/dL (urea >15 mmol/L)
- Start dialysis when BUN is consistently >48-56 mg/dL (urea >17-20 mmol/L)
- Urea fetotoxicity is the primary pregnancy-specific indication
Dialysis Dose (most important)
- Minimum 20 h/week, ideally ≥36 h/week
- Daily or nocturnal sessions are preferred
- Target midweek predialysis BUN <35 mg/dL (strict) or <50 mg/dL (minimum)
- Intensification improves gestational age and birth weight (meta-analysis confirmed)
Dialysate
- Bicarbonate adjusted to keep serum HCO3 at 18-22 mmol/L (pregnancy normal)
- Phosphate supplementation often needed (hypophosphatemia risk with intensive HD)
- Calcium maintained normal via vitamin D and dialysate calcium adjustment
Anemia
- Target Hb 10-11 g/dL
- Increase ESA dose by 50-100%; IV iron to maintain stores
- Both are safe in pregnancy
Nutrition
- Protein 1.5-1.8 g/kg/day
- Folic acid 1-5 mg/day, Aspirin 75-150 mg/day
- Vitamin D levels checked each trimester
Volume/BP
- Dry weight adjusted for expected weight gain (~0.5-1 kg/wk by midpregnancy)
- Avoid ACE inhibitors, ARBs, and aggressive ultrafiltration
- Avoid hypotension (risks uteroplacental insufficiency)
Sources: Comprehensive Clinical Nephrology 7th Ed (Box 45.6), Creasy & Resnik Maternal-Fetal Medicine (Table 57.6), NKF Primer on Kidney Diseases 8th Ed
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