"hemodialysis" AND "pregnancy" AND "prescription"

hemodialysis prescription in pregnancy guidelines 2024 intensive dialysis

A professional medical educational poster titled "Hemodialysis Prescription in Pregnancy" with a clean clinical design on a dark navy blue background with white and teal/cyan accent colors. The poster is organized in clearly labeled sections with icons: TOP HEADER: Large bold title "HEMODIALYSIS PRESCRIPTION IN PREGNANCY" with subtitle "Evidence-Based Clinical Guidance" and a small kidney/pregnant silhouette icon. SECTION 1 - "DIALYSIS DOSE TARGET" (teal box): - Aim: ≥36 hours/week (established HD patients) - Daily or nocturnal HD preferred - Graded by residual kidney function - Midweek pre-dialysis BUN < 35 mg/dL (urea < 12.5 mmol/L) - Live birth rate 86% with ≥43 hrs/wk vs 61% with 17 hrs/wk SECTION 2 - "WHEN TO INITIATE DIALYSIS IN PREGNANCY" (orange box): - BUN > 42 mg/dL (urea > 15 mmol/L): initiate discussion - BUN > 48–56 mg/dL (urea 17–20 mmol/L): initiate HD - Standard indications: hyperkalemia, acidosis, fluid overload, uremic symptoms - Consider gestation ≥34 wks: risk of preterm delivery vs dialysis SECTION 3 - "BIOCHEMICAL TARGETS" (purple box, 2-column): - Hemoglobin: 10–11 g/dL (ESA + IV iron) - Bicarbonate: 18–22 mmol/L (adjust dialysate) - Serum phosphate: maintain normal range (supplement oral/dialysate) - Serum calcium: normal range (vitamin D analogues) - Blood pressure: < 140/90 mmHg (avoid ACEi/ARBs) SECTION 4 - "DRY WEIGHT & FLUID MANAGEMENT" (green box): - Increase target dry weight ~0.5 kg/week throughout pregnancy - Avoid hypovolemia — threatens uteroplacental blood flow - Reassess dry weight at each session SECTION 5 - "ANTICOAGULATION" (red box): - Heparin requirement may increase (hypercoagulability of pregnancy) - UFH preferred; adjust dose accordingly - Monitor for bleeding risk SECTION 6 - "NUTRITION" (yellow-orange box): - Increased protein requirements - Dietitian involvement essential - Folic acid 5 mg/day pre-pregnancy and throughout - Supplement dialysate phosphate if needed SECTION 7 - "FETAL MONITORING" (blue box): - Weekly fetal surveillance after 24 weeks - Monitor for IUGR, polyhydramnios, preterm labor - Collaborative care with Maternal-Fetal Medicine SECTION 8 - "POST-PARTUM" (grey box): - Return to standard dialysis schedule - Reassess dry weight and antihypertensives weekly for 6–12 weeks FOOTER: Small text "Sources: Comprehensive Clinical Nephrology 7e, Brenner & Rector's The Kidney, KDIGO 2025, UK Renal Association Guidelines 2019" Layout: 2-3 column grid with colored section boxes, clear medical typography, no clutter, professional infographic style suitable for hospital display.

A professional medical educational poster titled "Hemodialysis in Pregnancy" with a clean modern clinical design. White background with deep blue, teal, and coral/red accent colors. Organized in a structured grid layout with colored header bands and icons throughout. TOP HEADER BAND (deep navy blue, full width): Large white bold title: "HEMODIALYSIS IN PREGNANCY" Subtitle: "Prescription & Management Quick Reference" Right side: stylized icon of a pregnant woman with dialysis tubing ROW 1 - Three columns side by side: LEFT BOX (deep blue, "DIALYSIS DOSE"): ★ Established on HD before pregnancy: → Target ≥ 36 hrs/week → Ideally daily or nocturnal HD → Max reported: 43 ± 6 hrs/wk ★ Started on HD during pregnancy: → Titrate by residual kidney function → 24-hr urine creatinine & urea clearance ★ Outcome data: → ≥37 hrs/wk: live birth rate 86% → ~17 hrs/wk: live birth rate 61% → Each extra hr/wk → longer gestation MIDDLE BOX (teal, "BUN / UREA TARGETS"): 🎯 Pre-dialysis midweek BUN: < 35 mg/dL (urea < 12.5 mmol/L) 📌 Initiation thresholds: • Discuss: BUN > 42 mg/dL (urea >15) • Initiate: BUN 48–56 mg/dL (urea 17–20) ⚠ Also initiate for: • Hyperkalemia • Metabolic acidosis • Uremic symptoms • Refractory fluid overload • ≥34 wks: weigh vs preterm delivery risk RIGHT BOX (coral/red, "FLUID & DRY WEIGHT"): ⚖ Dry weight adjustments: → Increase ~0.5 kg/week → Reassess every session 🚫 AVOID hypovolemia: → Threatens uteroplacental flow → Risk of fetal distress 💧 Volume overload risks: → Hypertension → Pulmonary edema → Polyhydramnios ROW 2 - Three columns: LEFT BOX (purple, "BIOCHEMICAL TARGETS"): 🔴 Hemoglobin: 10–11 g/dL IV iron to maintain stores ESA dose adjustment required 🟡 Bicarbonate: 18–22 mmol/L Adjust dialysate bicarbonate 🟢 Phosphate: Normal range Oral or dialysate supplementation 🔵 Calcium: Normal range Vitamin D / analogues ⬛ K⁺: Avoid hypokalemia Adjust dialysate K⁺ MIDDLE BOX (orange, "MEDICATIONS"): ✅ SAFE / USE: • Folic acid 5 mg/day • Aspirin 75–150 mg/day • ESA (erythropoietin) • IV iron • UFH (heparin — may need ↑ dose) • Methyldopa, labetalol, nifedipine (BP) • Vitamin D analogues ❌ AVOID: • ACE inhibitors • ARBs (angiotensin receptor blockers) • Renin inhibitors • NSAIDs ⚠ MgSO₄: use cautiously — monitor levels RIGHT BOX (green, "MONITORING & MDT"): 👶 Fetal surveillance (from 24 wks): • Weekly growth scans • Umbilical artery Doppler • Watch: IUGR, polyhydramnios, preterm labour 🩺 Maternal monitoring: • BP at every session • Weekly bloods: BUN, electrolytes, Hb • Fluid status each session • Heparin: adjust for hypercoagulability 👥 MDT: Nephrology + MFM + Dietitian + Neonatology + Pharmacy BOTTOM BAND (light grey, two columns): LEFT - "POST-PARTUM CARE": • Return to standard HD schedule • Reassess dry weight weekly × 6–12 wks • Titrate antihypertensives as volume changes • Monitor for post-partum haemorrhage RIGHT - "PRE-PREGNANCY COUNSELLING": • Discuss risks: preterm birth, IUGR, miscarriage • Optimize dialysis dose before conception • Review all medications • Folic acid 5 mg/day pre-conception • Consider transplant if eligible VERY BOTTOM FOOTER (navy): Small white text: "Sources: Comprehensive Clinical Nephrology 7e · Brenner & Rector's The Kidney · KDIGO Women & Kidney Health 2025 · UK Renal Association Guidelines 2019" Clean infographic style, professional medical typography, well-spaced text, suitable for hospital/clinic display.