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Community Minded

Dialysis Decisions in Pregnancy Pre-ESRD

We recently had two dialysis-in-pregnancy posts: “Pregnant Transplant Patient with Poor Renal Function” and “Pregnant Patient With CKD 4”. Clear guidelines exist on managing the rare ESRD pregnant patient, but there is less known about how to manage pre-ESRD CKD and pregnancy. In the former, renal replacement therapy (RRT) is increased to target a weekly KT/V as high as 6-8 and a BUN as low as <20 mg/dl. But when do you start RRT on a non-ESRD CKD pregnant patient, and given that for any level of BUN and creatinine, that patient should healthier than an anuric patient on dialysis, should the BUN target be different? These important questions are pondered in these posts.
Summary provided by Roger Rodby, MD, MS

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