ntil after kidney transplantation. Pregnancy rates in women with advanced kidney failure or receiving dialysis remain low, and despite the improved outcomes in recent years, these pregnancies remain high risk for both mother and baby with high rates of preterm birth due to both maternal and fetal complications. However, with increased experience and advances in models of care, this paradigm may be changing. Intensive hemodialysis regimens have been shown to improve both fertility and live-birth rates. Increasing dialysis intensity and individualizing dialysis prescription to residual renal function, to achieve highly efficient clearances, has resulted in improved live birth rates, longer gestations and higher birth weights. Intensive hemodialysis regimens, particularly nocturnal and home-based dialysis, are therefore, a potential option for women with kidney failure desiring pregnancy. Global initiatives for the promotion and uptake of home-based dialysis are gaining momentum and may have advantages in this unique patient population. In this article we review the epidemiology and outcomes of pregnancy in hemodialysis and peritoneal dialysis recipients. We discuss the role home-based therapies may play in helping women achieve more successful pregnancies and outline the principles and practicalities of management of dialysis in pregnancy with a focus on delivery of home modalities. The experience and perspectives of a patient are also shared. Pregnancy is an important goal for many women with chronic kidney disease (CKD) or kidney failure, but important barriers exist, particularly as CKD stage progresses. Women with advanced CKD often have a limited fertility window and may miss their opportunity for a pregnancy if advised to defer until after kidney transplantation. Pregnancy rates in women with advanced kidney failure or receiving dialysis remain low, and despite the improved outcomes in recent years, these pregnancies remain high risk for both mother and baby with high rates of preterm birth due to both maternal and fetal complications. However, with increased experience and advances in models of care, this paradigm may be changing. Intensive hemodialysis regimens have been shown to improve both fertility and live-birth rates. Increasing dialysis intensity and individualizing dialysis prescription to residual renal function, to achieve highly efficient clearances, has resulted in improved live birth rates, longer gestations and higher birth weights. Intensive hemodialysis regimens, particularly nocturnal and home-based dialysis, are therefore, a potential option for women with kidney failure desiring pregnancy. Global initiatives for the promotion and uptake of home-based dialysis are gaining momentum and may have advantages in this unique patient population. In this article we review the epidemiology and outcomes of pregnancy in hemodialysis and peritoneal dialysis recipients. We discuss the role home-based therapies may play in helping women achieve more successful pregnancies and outline the principles and practicalities of management of dialysis in pregnancy with a focus on delivery of home modalities. The experience and perspectives of a patient are also shared. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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接受家庭透析的患者怀孕

直到肾移植后。患有晚期肾衰竭或接受透析的妇女的怀孕率仍然很低，尽管近年来结果有所改善，但这些怀孕对母亲和婴儿来说仍然是高风险，由于母体和胎儿并发症，早产率很高。然而，随着经验的增加和护理模式的进步，这种模式可能正在改变。强化血液透析方案已被证明可以提高生育率和活产率。增加透析强度并根据残余肾功能个体化透析处方以实现高效清除，从而提高了活产率、延长妊娠期和提高出生体重。因此，强化血液透析方案，特别是夜间透析和家庭透析，是肾功能衰竭想要怀孕的女性的潜在选择。全球推广和采用家庭透析的举措正在获得动力，并且可能在这一独特的患者群体中具有优势。在本文中，我们回顾了血液透析和腹膜透析接受者的流行病学和妊娠结局。我们讨论了家庭疗法在帮助女性更成功怀孕方面可能发挥的作用，并概述了妊娠期透析管理的原则和实用性，重点是家庭分娩方式。还分享了患者的经验和观点。对于许多患有慢性肾病 (CKD) 或肾衰竭的女性来说，怀孕是一个重要的目标，但存在重要的障碍，特别是随着 CKD 阶段的进展。患有晚期 CKD 的女性的生育窗口通常有限，如果建议推迟到肾移植后，可能会错过怀孕的机会。患有晚期肾衰竭或接受透析的妇女的怀孕率仍然很低，尽管近年来结果有所改善，但这些怀孕对母亲和婴儿来说仍然是高风险，由于母体和胎儿并发症，早产率很高。然而，随着经验的增加和护理模式的进步，这种模式可能正在改变。强化血液透析方案已被证明可以提高生育率和活产率。增加透析强度并根据残余肾功能个体化透析处方以实现高效清除，从而提高了活产率、延长妊娠期和提高出生体重。因此，强化血液透析方案，特别是夜间透析和家庭透析，是肾功能衰竭想要怀孕的女性的潜在选择。全球推广和采用家庭透析的举措正在获得动力，并且可能在这一独特的患者群体中具有优势。在本文中，我们回顾了血液透析和腹膜透析接受者的流行病学和妊娠结局。我们讨论了家庭疗法在帮助女性更成功怀孕方面可能发挥的作用，并概述了妊娠期透析管理的原则和实用性，重点是家庭分娩方式。还分享了患者的经验和观点。版权所有 © 2024 美国肾脏病学会...