TY - JOUR
T1 - Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease
T2 - an international observational study
AU - Jesudason, Shilpanjali
AU - Hewawasam, Erandi
AU - Moloney, Brona
AU - Tan, Rachel
AU - Li, Joule
AU - Blakey, Hannah
AU - Bramham, Kate
AU - Hall, Matthew
AU - Juneja, Rajiv
AU - Jarvis, Elizabeth
AU - Lightstone, Liz
AU - Lipkin, Graham
AU - Hladunewich, Michelle A.
N1 - Funding Information:
Open Access funding enabled and organized by CAUL and its Member Institutions. We acknowledge that EH is supported by Professor Stephen McDonald, Chief Investigator for the “BEAT-CKD” NHMRC Program Grant (APP1092957), for which SJ also is an Associate investigator.
Publisher Copyright:
© 2022, Crown.
PY - 2022/7
Y1 - 2022/7
N2 - Background: Evidence surrounding vascular access options for commencing dialysis in pregnancy complicated by chronic kidney disease (CKD) is limited. Creation of new arteriovenous fistulas (AVFs) in pregnant women is rare. Methods: Retrospective cohort study of approaches to vascular access in pregnancy in centres in Australia, the United Kingdom (UK) and Canada (2002–2018). Results: Twenty-three women with advanced CKD commenced dialysis in pregnancy (n = 20) or planned to commence (n = 3). Access at dialysis start was a tunnelled catheter (n = 13), temporary catheter (n = 1), AVF created pre-conception but used in pregnancy (n = 3) and AVF created during pregnancy (n = 3). No women commencing dialysis with an AVF required a catheter. No differences in perinatal outcomes were observed comparing AVFs and catheters at dialysis commencement. No AVFs were created in pregnancy in Canadian women. From Australia and the UK, 10 women had a new AVF created in pregnancy, at median gestation 14.5 weeks (IQR 12.5, 20.75). Four women still needed a catheter for dialysis initiation and 3 eventually used the new AVF. Six AVFs were successfully used in pregnancy at median gestation 24 weeks (IQR 22.5, 28.5), 2 were successfully created but not used and 2 had primary failure. No catheter-associated complications were identified except one episode of catheter-related sepsis. Conclusions: Catheter-related complications were minimal. In selected women, with sufficient pre-planning, an AVF can be created and successfully used during pregnancy to minimise catheter use if preferred. Pre-conception counselling in advanced CKD should include discussing vascular access options reflecting local expertise and patient preferences. Graphic abstract: [Figure not available: see fulltext.]
AB - Background: Evidence surrounding vascular access options for commencing dialysis in pregnancy complicated by chronic kidney disease (CKD) is limited. Creation of new arteriovenous fistulas (AVFs) in pregnant women is rare. Methods: Retrospective cohort study of approaches to vascular access in pregnancy in centres in Australia, the United Kingdom (UK) and Canada (2002–2018). Results: Twenty-three women with advanced CKD commenced dialysis in pregnancy (n = 20) or planned to commence (n = 3). Access at dialysis start was a tunnelled catheter (n = 13), temporary catheter (n = 1), AVF created pre-conception but used in pregnancy (n = 3) and AVF created during pregnancy (n = 3). No women commencing dialysis with an AVF required a catheter. No differences in perinatal outcomes were observed comparing AVFs and catheters at dialysis commencement. No AVFs were created in pregnancy in Canadian women. From Australia and the UK, 10 women had a new AVF created in pregnancy, at median gestation 14.5 weeks (IQR 12.5, 20.75). Four women still needed a catheter for dialysis initiation and 3 eventually used the new AVF. Six AVFs were successfully used in pregnancy at median gestation 24 weeks (IQR 22.5, 28.5), 2 were successfully created but not used and 2 had primary failure. No catheter-associated complications were identified except one episode of catheter-related sepsis. Conclusions: Catheter-related complications were minimal. In selected women, with sufficient pre-planning, an AVF can be created and successfully used during pregnancy to minimise catheter use if preferred. Pre-conception counselling in advanced CKD should include discussing vascular access options reflecting local expertise and patient preferences. Graphic abstract: [Figure not available: see fulltext.]
KW - Arteriovenous fistula
KW - Dialysis
KW - Kidney disease
KW - Pregnancy
KW - Vascular access
UR - http://www.scopus.com/inward/record.url?scp=85127244268&partnerID=8YFLogxK
U2 - 10.1007/s40620-022-01288-y
DO - 10.1007/s40620-022-01288-y
M3 - Article
C2 - 35347647
AN - SCOPUS:85127244268
SN - 1121-8428
VL - 35
SP - 1689
EP - 1698
JO - JOURNAL OF NEPHROLOGY
JF - JOURNAL OF NEPHROLOGY
IS - 6
ER -