Pregnancy Outcomes in Egyptian Women on Maintenance Hemodialysis: A Multicenter Observational Study

Main Article Content

Abir Farouk Megahed
Ghada El Kannishy
Hassan El Azawy
Hanan Farouk Megahed
Ehab Hussein Hashish
Nagy Sayed- Ahmed


Background and Aims: Women in the childbearing period on hemodialysis (HD) have decreased fertility when compared with the general population. However, pregnancy in this patients’ population is still possible. The aim of the current study was to assess the conception rate in Egyptian HD females.

Methods: The study comprises 2 phases: phase one studied the frequency of conception in HD females in Egypt, while phase two studied the live birth frequency and factors affecting it in 22 hemodialysis units (HDUs) including 211 females with sexually active partner in their childbearing period comprising 33 females with HD coincidental pregnancies.

Results: 5-year conception rate was 5.2%, and was associated with higher planned dialysis dose (higher blood flow rate, larger dialyzer size, and session length), better control of blood pressure, as well as a lower level of serum ferritin. Live birth frequency was 33.3% and was statistically significantly associated with younger age of the pregnant lady, higher length of dialysis sessions, lower serum phosphorus level, and suggested better nutrition. There was no maternal mortality associated with HD coincidental pregnancies. There was a better neonatal outcome observed with the caesarian section.

Conclusion: Fertility is possible and safe in Egyptian HD female with a sexually active partner as there is no maternal mortality but not as such for the fetal outcome. Better conception potentials and the outcome are related to better-planned dialysis dosing and adequate control of phosphate and inflammation.

Conception, egyptian HD female, HD coincidental pregnancies, mode of delivery, pregnancy outcome.

Article Details

How to Cite
Megahed, A. F., Kannishy, G. E., Azawy, H. E., Megahed, H. F., Hashish, E. H., & Ahmed, N. S.-. (2020). Pregnancy Outcomes in Egyptian Women on Maintenance Hemodialysis: A Multicenter Observational Study. Asian Journal of Medicine and Health, 18(10), 1-17.
Original Research Article


Bahadi A, El Kabbaj, D Guelzim K, Kouach J, Hassani M, Maoujoud O, et al. Pregnancy during Hemodialysis: A Single-Center Experience. SJKDT. 2010;21(4): 646-51.

Barua M, Hladunewich M, Keunen J, Pierratos A, Farlane P Mc, Sood M, et al. Successful Pregnancies on Nocturnal Home Hemodialysis. CJASN. 2008;3(2):392-96.

Malik GH, Al-Harbi A, Al-Mohaya S, Dohaimi H, Kechrid M, Shetaia MS, et al. Pregnancy in patients on dialysis-experience at a referral center. J Assoc Physicians India. 2005;53:937-41.

Hou S. Pregnancy in women treated with dialysis: lessons from a large series over 20 years. Am J Kidney Dis. 2010;56(1):5-6.

Confortini P, Galanti G, Ancona G. Full-term pregnancy and successful delivery in a patient on chronic hemodialysis. Proc Eur Dial Transplant Assoc. 1971;8:74-80.

Reddy SS, Holley JL. Management of the pregnant chronic dialysis patient. Adv Chronic Kidney Disease. 2007;14(2):146-55.

Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis. 1999;33(2):235-52.

Manisco G, Potì M, Maggiulli G, Di Tullio M, Losappio V, Vernaglione L. Pregnancy in end-stage renal disease patients on dialysis and how to achieve a successful delivery CKJ Review. Clin Kidney J. 2015;8:293-99.

Jesudason S, Grace BS, McDonald SP. Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD. Clin J Am Soc Nephrol. 2014;9:143-49.

Nageotte MP, Grundy HO. Pregnancy outcome in women requiring chronic hemodialysis. Obstet Gynecol. 1988;72:456-59.

Gafter U, Peleg D, Korzets A, Zevin D, Landman J, Goldman J, et al. Successful pregnancies in women on regular hemodialysis treatment. Isr J Med Sci. 1990;26:266-70.

Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. AJKD. 1998;31(5):766-73.

Shahir A K, Briggs N, Katsoulis J, Levidiotis V. An observational outcomes study from 1966–2008, examining pregnancy and neonatal outcomes from dialyzed women using data from the ANZDATA Registry. Asian Pacific Society of Nephrology. 2013;18(4):276-84.

Kalantar-Zadeh, K, Rudolph A. Rodriguez, Michael H. Humphreys, Association between serum ferritin and measures of inflammation, nutrition and iron in hemodialysis patients. Nephrology Dialysis Transplantation. 2004;19(1):141-49.

Kell DB, Pretorius Es. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics. 2014;6:748-73.

Piccoli GB, Cabiddu G, Daidone G, Guzzo G, Maxia S, Ciniglio I, et al. The children of dialysis: live-born babies from on-dialysis mothers in Italy--an epidemiological perspective comparing dialysis, kidney transplantation, and the overall population. Nephrol Dial Transplant. 2014;29(8):1578-86.

Hou.SH Frequency and Outcome of Pregnancy in Women on Dialysis. American Journal of Kidney Diseases. 1994;23(1):60-63.

Souqiyyeh MZ, Huraib SO, Saleh AG, Aswad S. Pregnancy in chronic hemodialysis patients in the Kingdom of Saudi Arabia. Am J Kidney Dis. 1992;19(3): 235-38.

Eroglu D, Lembet A, Ozdemir FN, Ergin T, Kazanci F, Kuşcu E, et al. Pregnancy during hemodialysis: perinatal outcome in our cases. Transplant Proc. 2004;36(1):53-55.

Vidal M L, Ursu M, Martinez A, Roland S S, Wibmer E, Pereira D, et al. Nutritional control of pregnant women on chronic hemodialysis. Journal of Renal Nutrition. 1998;8(3):150-56.

Villa G, Montagna G, Segagni S. Pregnancy in chronic dialysis: a case report and review of the literature. G Ital Nefrol. 2007;24:132-40.

Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M, et al. Intensive hemodialysis associates with improved pregnancy outcomes: A Canadian and United States cohort comparison. J Am Soc Nephrol. 2014;25:1103-09.

Kushner DH. Fertility in women after age forty-five. Int J Fertil. 1979;24(4):289-90.

Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis. 1998;31(5):756-65.

Giatras I, Levy DP, Malone FD, Carlson JA, Jungers P. Pregnancy during dialysis: case report and management guidelines. Nephrol Dial Transplant. 1998;13(12):3266-72.

Piccoli GB, Minelli F, Versino E, Cabiddu G, Attini R, Vigotti FN, et al. Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrol Dial Transplant. 2016;31:1915-34.

Alkhunaizi A, Melamedb N, Hladunewich MA. Pregnancy in advanced chronic kidney disease and end-stage renal disease. Curr Opin Nephrol Hypertens. 2015;24:252-59.

Hogberg U, HaKansson S, Serenius F, Holmgren P A. Extremely preterm cesarean delivery: a clinical study. Acta Obstetricia et Gynecologica. 2006;85:1442-47.

Alfirevic Z, Milan S J, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev. 2012;6(6):CD000078. DOI:10.1002/14651858.CD000078.pub2.

Malamitsi-Puchner A, Protonotariou E, Boutsikou T, Makrakis E, Sarandakou A, Creatsas G. The influence of the mode of delivery on circulating cytokine concentrations in the perinatal period. Early Human Development. 2005;81(4):387-92.

Tan LK, Kanagalingama D, Tana, HK, Choong HL. Obstetric outcomes in women with end-stage renal failure requiring renal dialysis. International Journal of Gynecology and Obstetrics. 2006;94:17-22.

Bamberg C, Diekmann F, Haase M, Budde K, Hocher B, Halle H, et al. Pregnancy on Intensified Hemodialysis: Fetal Surveillance and Perinatal Outcome. Fetal Diagn Ther. 2007;22:289-93.

Chow YH, Dattani N, Hilder L, Macfarlane A, Moser K. Introducing new data on gestation-specific infant mortality among babies born in 2005 in England and Wales. Health Stat Q. 2007;35:13-27.

Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive and behavioral outcomes of school-aged children who were born preterm: A meta-analysis. JAMA. 2002;288:728-37.

Zeitlin J, Draper ES, Kollee L, Milligan D, Boerch K, Agostino R, et al. MOSAIC Research Group: Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort. Pediatrics. 2008;121:936-44.

Hou S. Modification of dialysis regimens for pregnancy. The International Journal of Artificial Organs. 2002;25(9):823-26.

37-Karampatou A, Han X, Kondili L A, Taliani G, Ciancio A, Morisco F, et al. Premature ovarian senescence and a high miscarriage rate impair fertility in women with HCV. Journal of Hepatology. 2018;68:33-41.

38-Ansari M H K and Omrani. M D. Evaluation of Diagnostic Value of Elisa Method (EIA) & PCR in Diagnosis of Hepatitis C Virus in Hemodialysis Patients. Hepatitis Monthly. 2006;6:19-23.